“Are you in network with my insurance?” or “Do you take Metlife” or “Why aren’t you on the list of dentists my insurance wants me to go to?”
These are questions we are frequently asked by patients, and we hope to clear up much of the confusion when we answer them. At Smile Hilliard, we are able to accept any insurance plan where a patient has the freedom to choose their provider. We are unable to accept Medicare, Medicaid, Molina, CareSource and DMO/HMO plans where you are assigned by your insurance company to a specific dentist.
Whether we are a participating provider (i.e., in network) with the plan is a separate question. However, when patients ask whether we “take” their plan, 99% of the time, what they are really asking is “are you in my plan’s network?” This is a complicated question and one that deserves a fair answer.
What does it mean to be a “participating provider”?
Every dentist is solicited each year by several insurance companies to join their “family” of dentists as a participating provider. Contrary to popular belief, there is no quality control or screening process to select top dentists in the area. In fact, the insurance companies make no evaluation of a dentist’s clinical skills whatsoever. Basically, the only two prerequisites to join an insurance network are 1.) Do you have a license to practice dentistry? and 2.) Do you have a heartbeat?
Insurance companies want dentists to contract with them for two reasons. First, they need to have penetration into an area to be able to sell their policies to employers. Without contracted dentists in the area, why would an employer want to buy their plan? Second, insurance companies want to pay out less in benefits and keep more in profits. By pushing their policyholders towards in network providers, they accomplish both of those goals. Insurance companies actually have no interest in patient care or helping their policyholders. In fact, they hope you purchase their product and never use it! They are for-profit businesses that exist to make money, period.
Why does a dentist join an insurance network?
So why do some dentists choose to join insurance networks? The answer is simple…to attract new patients to their practice. Contracted dentists agree to a 25-50% reduction of their fees in exchange for this constant patient stream. Being in network and accepting a fee reduction is simply a marketing cost.
New practices have mammoth start-up debt and are desperate to fill their treatment chairs, so they make the mistake of participating with every plan they can in order to quickly grow their patient base. They soon realize that the reduced fees they have agreed to accept barely cover their operating costs.
In order to make up the loss of revenue, contracted dentists must see a higher volume of patients and must agree to play by the insurance company’s rules, in essence letting them dictate the patient’s care. This can have a negative effect on the amount of time spent with patients, the quality of support staff, the quality of materials and dental labs used, etc.
Unfortunately, the only winner here is the insurance company. It isn’t the patient. And it certainly isn’t the dentist. Ask yourself this…would you be willing to work harder for less money? That is exactly what a dentist does when joining an insurance network.
How does my dental insurance work at Smile Hilliard?
We are an unrestricted provider with all dental benefit policies, so you will not find us on the preferred provider list for any insurance company. As an unrestricted provider, this allows us to treat you based on your needs and your doctor’s recommendations, without any of the restrictions imposed by your dental carrier on their participating dentists.
The insurance industry has conditioned its policyholders to believe that they must see a contracted provider in order to reap the value of their benefits. Contrary to popular belief, most dental policies have the same coverage levels whether you see a contracted provider or not…however, every plan is different. The vast majority of our patients are able to use their benefits at our office and most have no patient cost for their preventative care (exams, x-rays, cleanings, etc.), same as they would at a participating provider.
We understand that, in the real world, costs matter. We are happy to do a complete dental benefits verification prior to your appointment and let you know how we can best make your coverage work on your behalf. We are experts at this and do it daily! We can even send a pre-determination prior to any treatment so you can know your coverage and any associated patient costs without any surprises.
Your insurance company would certainly prefer you to see a contracted dentist, as they are then able to retain more of your benefits and pay less to your dentist for your care. However, this is definitely not in your best interests and only benefits the insurance carrier. In this time of rampant inflation where supply chain issues affect us daily, a participating dentist will most certainly have a difficult time providing the quality of care you deserve. Dental employees are in short supply and are demanding higher wages every day and the cost of supplies, materials and other overhead is increasing rapidly. Contracted dentists are being forced to cut corners to remain profitable under the severely reduced fees they must accept to remain in the network.
In the post-pandemic era, the insurance landscape is changing. More and more insurance carriers are crying poverty (while reaping record profits) and are not only refusing the negotiate fees with their contracted dentist but are many cases even decreasing contract dentists’ fees. This has created a split where most small, private practices such as ours are choosing to discontinue participation as it has become unsustainable as a business model. This is resulting in less and less choice for patients who desire to stay withing their insurance network. Soon, in many cases, the only option for these patients will be corporate dentistry, where they play a volume game and its quantity over quality.
The corporate dental experience is very different than what patients receive at our office. We believe our patients deserve better than allowing their insurance company so much control over their dental care. We provide a higher standard of care and the personal attention and level of service that our patients and their family deserve. At our office, we don’t rush you through appointments, we run on time every time, and you see the same great dental team at every visit. We truly partner with you in your dental care and get to know you as a patient…you are not just a number!
As an unrestricted provider, we are able to build a better partnership with our patients which allows you to make the decisions about your care rather than your dental plan. We treat the patient, not the insurance company!
What options do I have outside of traditional insurance?
The term “dental insurance” is actually very misleading. Dental insurance is not insurance at all. It is more of a discount program (think “dental coupons”) that an employer pays into based on what they can afford. It is not intended to cover the full cost of your dental care. While some employers may have the funds to purchase significant dental discounts and savings for their employees, more and more are looking to reduce dental coverage for their employees or eliminating it altogether as a cost savings measure.
We believe that everyone deserves the same equal access to dental care, regardless of what their employer contributes to their plan. If you do not have access to dental insurance, or find that your coverage is less than satisfactory, we offer an equitable alternative. Many of our patients are choosing to drop their dental coverage (and their expensive premiums) and cut out the insurance middleman altogether by joining our in-house Smile Hilliard Membership Club.
For a low monthly fee, you will receive your preventive care (exams, x-rays, cleanings and fluoride treatment) covered in full at our office as well as a 15% fee courtesy on all other treatment! There are three membership options: The Adult HealthCare Membership, the Child HealthyCare Membership and the Adult PerioCare Membership (for those patients who require more frequent visits). There are no annual maximums, deductibles, waiting periods, restrictive clauses, denials, or claims to file! More information is available on our website, or feel free to give us a call at (614) 534-0257 if you have any questions.
Affordable Family Dental Care in Hilliard, Ohio
Smile Hilliard is committed to managing your dental benefits for you so you can get the most out of your plan and focus on the excellent dental care that we offer. Explore our extensive range of available dental services, learn more about our in-house financing options and schedule an appointment today.