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| Страхование |
| Форум врача-дантиста Ларисы Лахман. Медицинские страховки. |
Larissa Lachman
Boston |
Все виды стоматологических услуг. Высокий уровень обслуживания.
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Alex
San Francisco |
I have dental insurance AetnaHealthcare. It allows me to go to any dentist of my choice. It covers a 100% for all the preventive services, i.e. cleanings, x-rays, emergencies.
However, after I used my new insurance for the first time, I received a bill for a relatively small amount from my dentist. I was very surprised. It says very clearly in my benefit packet that it should have been covered completely, no COpayment.
What is going on? Is my dentist over-charging me?
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Larissa Lachman
Boston |
No, your dentist is NOT over-charging you. Your insurance company is cheating you out of a small amount of money.
Before I explain this situation further, let state that the American Dental Association is involved right now in a legal battle with your insurance company over these exact problems.
You are absolutely right. Your initial appointment should have been covered a 100%. Your insurance company did not cover your dentist's fees at a 100%. Instead, they covered a 100% of their fees. You should ask "What their fees?" Exactly. They are not in the business of treating patients. Some insurance companies come up with what they call "reasonable and customary" fees and pay up an appropriate percentage of THAT number. Nobody knows WHERE they get those numbers. Moreover, when approached they could not substantiate those numbers. The idea is to pay as little as possible and to get away with it.
Who is suffering from this system? The dentist and the patient do. The dentist is not obligated to adjust his/her fees to accommodate the insurance company. The only exception to this fact would be a situation where the dentist has a contractual agreement with a particular insurance company. In this case the patient would have to see a particular dentist on the list of providers for this insurance company. These dentists agree to a significantly lower rate of compensation for their services in exchange for getting more clients.
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Борис
Чикаго |
Посоветуйте пожалуйста хорошую зубную страховку. И вообще по каким признакам ее лучше выбирать?
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vovik
brighton |
Reasonable and customary ammount it is ammount that is like average fee for the service that dentists are charging in your area.If your dentist is overcharging("expensive dentist"), to insurance company, at least some, is not going to pay that difference.You will have to pay it.And for fees - insurance company does not get any fees from your pocket, because your dentist is sending bill to "middle" man-billing and claim proccessing centers, and than these centers process that claim.Not a insurance company.So - find less expensive dantist.I already done that - and for a year I paid nothing, except 25$ deductible.
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Dr.Lachman, dentist
Boston |
I bag to differ.
The dentists do not use "middle man-billing and claim processing center" for billing. The processing center is used for electronic submissions only.
What in your view is" an expensive dentist"?
Your responce is lacking specifics. Let me know what insurance company you have and what kind of treatment you received for you to pay $25.00 deductable. Usually, deductable is paid when type II or type III benefits are administered and those necessitate a co-payment besides the deductable.
Larissa N. Lachman, D.M.D.
185 Devonshire Street
Suite 410
Boston, MA 02110
617-350-7474
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Dr.Lachman, dentist
Boston |
Gladly.
The best dental insurance for a consumer is the one that saves you money. If a particular policy cost you $350.00 per year and you spend at least this amount or more, you are ahead of the game.
I always like to recommend Delta Dental. It is widely accepted by most high-quality practices. It allowes a patient to get treatment at a reduced rate. It is a progressive company. They move with the rapidly changing profession. For example, they cover 80% for one-surface posterior composite. They also started covering restoration of implants.
Larissa N. Lachman, D.M.D.
185 Devonshire Street
Suite 410
Boston, MA 02110
617-350-7474
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vovik
brighton |
I have Delta Dental.But the question is - Who is suppoused to pay,for example - ystanovit plomby, esli vse dantistu charged 75.00$,and you will send bill for 200$?
Insurance is not going to pay, at least not everyone.And if you have "expensive" dentist -your benefits will run out very very fast.
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Dr.Lachman, dentist
Boston |
The American Dental Association, along with two individual dentists, is suing Aetna, the giant health insurance company, for breach of contract and libel.
The suit also seeks class-action certification for all dentists who are not members of Aetna's dental network but who have received payments from the dental insurer. A critical issue in the suit is Aetna's payments to non-network dentists based on "usual and customary" charges as determined by the insurer. The suit charges that Aetna uses FLAWED data to arrive at these fees, setting them much lower than the true prevailing rates, and that the use of the frase "usual and customary" in explanation of benefits notices implies that a dentist whose fees are above those amounts is overcharging.
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