PATIENT INFORMATION

Insurance

During the past decade, dental benefit plans have become part of health care planning for many families.

Dental benefit plans are made available to employees, or members, through companies, unions, and associations, and may vary considerably from one plan to the next.

The range of benefits depends solely on what the purchaser wishes to offer employees or members. Based on the premium dollar paid per person, plans may cover as little as 10% or as much as 80% of dental services. Some plans exclude certain types of services, while other plans will cover a full range of dental services. The decision of how much to spend and what services will be covered rests solely with your employer and the insurance carrier.

As the number of patients covered by dental plans has increased, certain assumptions have become common, but are not necessarily true. Let me clarify:

• My fees are based on the disease on the disease level and condition present in the mouth, the treatment plan selected, and the time it takes to provide the necessary dental care. I do not believe it is in either of our best interests for me to compromise the treatment necessary to return you to health in order to accommodate an insurance program's maximum benefits, which may be considerably less than optimal. However, I am more than happy to discuss a treatment plan's advantages and disadvantages with you thereby involving you, rather than your insurance company, in the decision-making process about your health.
  
  
• The type of treatment you need and receive from me is based upon the severity of your disease and my professional judgment, and not on whether your are covered by a dental benefit plan.
  
  
• As a courtesy to you, my staff will complete the dental portion of the claim form. To expedite processing, make sure that your part of the form is filled out completely and accurately.
  
  
• If your dental benefit plan requests a "predetermination" or "prior authorization." I will submit a treatment plan form comparison by your insurance carrier. Remember that their review only compares the treatment plan with what your premium payment purchased. The insurance carrier does not care if you are sick, or how soon you get well. Theirs is a FINANCIAL INTEREST, not a health related one, so they cannot make this decision for you. In fact, the longer they take to review a claim, the longer they can refrain from paying on the premium your employer paid in. Since insurers make profit by leaving premiums invested in stock and money market, ONLY the insurer benefits from a delay in the treatment decision. The financial obligation for dental treatment is between you and this office. The insurance company is responsible to you and not to this office.
  
  
• If you receive a communication from your insurance carrier suggesting that my fee is over and above the usual and customary rate for the services provided to you, please do not accept this as true. The insurance carrier's reimbursement is determined solely by the amount of premium dollar paid by your employer. Lower premium payments result in lower reimbursements; higher premiums result in higher reimbursements.
  
  
• If, after our discussion, you believe that the dental benefits provided by your plan are inadequate, you may want to discuss the matter with your employer, union, or association, so that appropriate alternatives can be investigated.
  

My office staff will help you as much as possible in completing claim forms, handling insurance quires, processing follow-ups, lost claims, etc. No question is too small for you to ask, whether it is about your treatment, benefit plan, or statement. Stop in, or call, any time you have a question.

Respectfully Submitted,

Dr. Dominik Dubravec, DDS, MMSc

First Visit

Please bring you insurance card with you so we can copy if for your files. Full payment for your initial consultation is required at time of service.

Co-Payment

All co-payments are payable when you check in at the front desk.

HMO Patients

If a patient comes to us with a problem that they expect to be covered by medical insurance (biopsies, tumors, TMJ, infections, jaw deformities), they must have a referral from their primary care physician. A referral from a dentist is not adequate for medical insurance coverage. Obtaining a medical referral is the patient's responsibility. We cannot obtain the referral for you, and the referral cannot be obtained retroactively.

Medicare

Our office is not a Medicare provider. Therefore if you are covered by Medicare insurance, payment will be expected at time of service unless other arrangements have been made in advance.

Private & Group Insurance

As a courtesy, we will file your insurance claims for you. Upon receipt of an insurance payment, any balance due will be billed to you. If you have deposited an excessive co-payment, it will be refunded to you.