Frequently Asked Insurance Related Questions

Extraordinary Dentisty / Exceptional Care

1.) What insurance do you take?

We accept any indemnity (Unrestricted/”Regular”), DPO (Dental Preferred Organization), or PPO (Preferred Provider Organization). However, we are not registered as a “Preferred Provider” with any DPO/PPO plans for the following reasons:

“Preferred Provider” dentists are “preferred” by the insurance company because they have agreed to reduce their usual and customary fees by 20-30% in order to be listed in the plan’s booklet or website. The trade-off for the doctor is lower income, but higher volume, as the PPO insurance plan drives more new patients to the practice. The problem is that overhead in a quality dental practice in the San Francisco Bay Area runs 67-70%. In other words, a dentist who is part of a PPO may be working for “free” as there is no profit left after the fee is reduced by the insurance agreement. If the “Preferred” dentist provides the same level of quality care to a DPO/PPO patient, he must either do so at the “break-even” rate negotiated by the insurance carrier, or find ways to lower the cost of providing that service (i.e. doing it faster, using a less expensive lab or less expensive materials, shortcutting the procedure, seeing multiple patients simultaneously, etc.). These alternatives are not acceptable to us. Our philosophy is to treat our patients as we would treat beloved friends and family (i.e. our patients receive our undivided attention and the best dentistry we can provide!).

We cannot accept any HMO (Health Maintenance Organization) or DMO (Dental Maintenance Organization) plans as people covered by those plans are required to use specific doctors in order to be covered.

2.) What is the difference between HMO, DMO, PPO, DPO, and Indemnity insurance?

HMO (Health Maintenance Organization) or DMO (Dental Maintenance Organization) plans cover individuals only if they seek care from doctors on a specific list (“closed panel”). Patients are always free to seek care from dentists not on the list, but no benefits will be paid… period. These plans are usually inexpensive to purchase because the doctors on the list are usually paid very little for “covered services.” For example, dentists on that list probably receive a small sum of money from the insurance company every month whether the patient goes in for care or not. Since the additional compensation to the doctor for “covered services” provided is minimal, there is little monetary incentive for the practice to encourage patients to address issues when they are small. However, in many cases, bigger jobs (crowns and bridges) or “high-end” dentistry (inlays and onlays) are not “covered services” and the patient is required to pay for those procedures in full. Therefore, the problem with HMO/DMO plans is that they indirectly encourage dentists to “monitor” or “watch” small problems that would be quick and easy to address until either the patient gets new non-HMO/DMO insurance that would pay better for small procedures or the problem becomes big enough to require a “non-covered” procedure for which the patient would be responsible. An alternative strategy for some HMO/DMO doctors is to “upgrade” or “up-sell” the patient to a “nicer,” high-end piece of dentistry which is also not covered and therefore the patient’s responsibility. (Please understand that I am definitely in favor of providing “high-end” dentistry as long as the choice is best for the patient and not “over-selling” for the personal financial gain of the dentist). It is our belief that treatment recommendations should be based exclusively on what is in the best interest of the patient.

DPO (Dental Provider Organization) and PPO (Preferred Provider Organization) plans cover individuals no matter which dentist they see. However, benefits may be slightly better if the insured person sees a “preferred provider.” Dentists on the list are “preferred” by the insurance company because they have agreed to reduce their usual and customary fees by 20-30% in order to be listed in the plan’s booklet or website. The trade-off for the doctor is lower income, but higher volume as the PPO insurance plan drives more new patients to the practice. The problem is that overhead in a quality dental practice in the San Francisco Bay Area runs 67-70%. In other words, a dentist who is part of a PPO may be working for “free” as there is no profit left after the fee is reduced by the insurance agreement. If the “Preferred” dentist provides the same level of quality care to a DPO/PPO patient, he must either do so at the “break-even” rate negotiated by the insurance carrier, or find ways to lower the cost of providing that service (i.e. doing it faster, using a less expensive lab or less expensive materials, shortcutting the procedure, seeing multiple patients simultaneously, etc.). These alternatives are not acceptable to us. Our philosophy is to treat our patients as we would treat beloved friends and family (i.e. our patients receive our undivided attention and the best dentistry we can provide!).

INDEMNITY plans are “regular” or “traditional” insurance plans where the covered individual is free to go to any doctor they choose. The benefits remain the same, regardless of who the dentist is. Many of these plans define benefits based on the intensity of the procedures. For example, they may cover 100% of “diagnostic and preventive” procedures (exams, x-rays, cleanings, sealants), 80% of “basic” procedures (fillings, root canals, extractions), and 50% of “major” procedures (crowns, bridges, etc.).

Most plans have annual deductibles and maximums. It is always a good idea for covered individuals to familiarize themselves with the specific details of their plan as benefits vary widely. It is also important to understand that insurance is a tool to be used as assistance for payment of dental care, and NOT an absolute cover for all dental services. Unlike medical insurance where you meet a deductible and then the insurance pays practically everything after that, dental insurance pays only so much and the remainder is the patient’s responsibility. Most importantly, do not confuse the limits of your insurance plan with what your individual needs are. Insurance companies do not perform a comprehensive examination for you and then decide what to cover in accordance with your needs. The coverage is arbitrary and based simply on what you or your employer is willing to pay in premiums and what risks the insurance company is willing to accept in return. Only your dentist can advise you as to what is best for maintaining your oral health. (If your insurance does not cover a necessary procedure, do you need it any less?).

3.) What Financial Options Are Available?

For your convenience, we gladly accept cash, checks, debit cards, Visa, Master Card, American Express, and Discover card.

For extensive treatment we are willing to explore no-cost financing options to make quality treatment affordable.