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Dental PPO Dentist

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Dental PPO participation is important to many people.  Dr Timmerman is in network with Delta Dental of Washington (WDS or Washington Dental Service), Cigna DentalRegence Blue Shield,  Aetna DentalGuardian Dental, and Humana Dental (our Delta participation also allows us to be “in network” for Delta from other states). If you have coverage from ANY of these plans, you can know that we can make usage of your dental benefits EASY for you.

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It may be important to clarify from the start that dental insurance does not exist, but pre paid dental benefits are very common. Insurance (like home, medical, auto, or fire) is where we pay into a common fund and hope to NEVER use. It is certainly great to have when we NEED, but we don’t really WANT our house to burn down so we can use it. Coverage for triple bypass heart surgery is great, but I don’t WANT to have the treatment unless I NEED it.

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Dr Timmerman accepts ALL dental insurance that allows you to choose your dentist. Some plans REQUIRE you to go to specific offices (like Group Health or Kaiser Permanente), but most other plans allow you to see ANYONE, and encourage you to see someone IN the network. The percentages are higher, but the actual money paid is the same wherever you go. The easiest example is: PPO pays 100% of $100 item if seeing an IN network, dentist, but that exact $100 is only 90% of the $111 fee from an OUT of network office. If seeing an out of network dentist, that $11 must be paid by the patient.

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Probably the most confusing aspect to dental benefit plans is their rules and limitations. Most decisions are NOT made by a dentist when denied benefits, or “hoops to jump through” to get the chosen treatment, but are in fact decided by someone with little or zero background or training in dentistry. They simply know the plan rules and enforce them as they choose.

As experts, we know how to navigate your plan. We won’t let an insurance employee dictate our treatment or what we offer, but we certainly will play by their rules. This can be confusing to you, so be sure to ask for clarification in advance if necessary.

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Another confusing aspect to dental benefits is the annual maximum. While it may say “100% coverage”, be sure to know the ceiling to coverage. Most plans have a max up to $1000 or $1500 and some of the better plans pay up to $2000 per year. This means that if your treatment plan is $5000, the plan will only pay $2000, even if they say “100% coverage”. Some treatment plans can be broken into pieces and done over time, but some things (like a bridge) are done at a single time and can’t be broken up.

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To confuse even more, companies will use “UCR Tables” to determine benefits. They state that this is “usual, customary, and reasonable” but often is not any of the three. The tables are 50th, 60th, 70th, 80th, and 90th percentiles, so it is important to know which percentile your plan uses. Some plans pay 100% of the 50th percentile, yet not a single dentist has a fee at that number. The HR department at your employer may have simply chosen a plan that doesn’t pay as well as another plan.

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Some plans have rules that confuse everyone. If a cheaper alternative is possible, then they will only pay what would have been paid for that option, not what was actually done. For example, some plans will pay for a bridge if only missing a single tooth. However, if TWO teeth are missing, they will pay for a removable partial denture (sometimes called a flipper), ONCE in the patient’s lifetime.

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Some people feel that they MUST have a dental plan, but their employer does not offer ANY dental benefits. In this case, they purchased a plan individually. All financial planners will tell you that this is a very poor investment, as you will ALWAYS pay more out of pocket than you receive in benefit. Always.

The most common way is a mandatory waiting period. Often, the plan may contribute for a cleaning, but NOTHING else for 18 months. If your premium was $200 per month, you will pay $3600 before you can “do” anything, and then you will have $1000 maximum benefit per year. You will never catch up, receive more than you paid in.

Our “In Office Plan” is a much better investment.  Our annual fee includes basic care and a discount on treatment, with no waiting periods.

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In many cases, we CAN bill treatment to medical insurance, so be sure to bring your medical insurance information. Dentists are NOT in network with medical, but the benefits can still be used. The rule of thumb is anything below the gums may have coverage (dental implants, periodontal surgeries, gum grafts, bone grafts), and we routinely treat sleep apnea while billing medical insurance (there is NO dental benefit for sleep apnea). There is significant paperwork and time involved, so we DO ask for your patience.

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