All Posts tagged Dental insurance

What “Out of Network” Means To You


Why out of network?

Medicine Wheel Dental made the decision 37 years ago to be an “out of network” dental provider for the good of our patients. Being out of network enables Medicine Wheel Dental to:

  • Work for our patients and not the insurance companies
  • Allow more time to understand the patients’ individual needs
  • Prepare integrative and comprehensive treatment plans
  • Allows utilization of high quality dental materials

Don’t be fooled by your insurance company!

Dental benefits typically max out in the range of $1,000.00 to $2,000.00 per year. This range has been minimally adjusted in the last 40 years, not keeping pace with inflation. When a dental office contracts with an insurance company, that office accepts the insurances companies rates, terms, and conditions. For that dental office, this means they must rely on volume of patients to keep their doors open for business. For our patients in our practice, it means the same amount of insurance benefits regardless of whether the doctor is in network or out of network.

Is this style of benefits right for you?

As long as you have an “out of network” option available on your policy, Medicine Wheel Dental will file all of the paperwork necessary for you to receive reimbursement of the benefits owed to you. Medicine Wheel Dental does this by collecting your insurance information and then filing a claim electronically which is the quickest form of claim submission available. Medicine Wheel Dental offers 12 month no interest rate payment plans as accommodation for the inconvenience this method of reimbursement may create. Every person is different and special in their own way so at Medicine Wheel we have created a practice built around this important awareness.

If you have any questions regarding insurance, please contact us, we’re here to help you!


How Dental Insurance Works at Medicine Wheel Dental

How Dental Insurance Works at Medicine Wheel Dental

At Medicine Wheel Dental & Wellness Center we made the conscious choice long ago that we would not subscribe to any particular dental insurance company who would be in a position to dictate our covered services and therefore, how and what we schedule. This would affect our ability to allocate the substantial time to our patients which we find to be a necessity in our practice. In other words, we work for our patients and not the insurance companies.

We do however encourage each patient to utilize their dental insurance coverage (if applicable) and interestingly enough, while the coverage seems to be quite a bit less when going to an “out of network” office, it ends up being basically the same benefits when you use them at Medicine Wheel.

Let us explain how… It is a discouraging fact that for most people today, dental insurance benefits are the same as they were in the 70’s. The biggest change (other than dental advancements) is the cost. Unfortunately this sector of insurance has not evolved with the high fluctuation in dental office’s overhead. Most insurance companies will cover $1,000 – $1,500 annually (there are some exceptions for slightly better coverage). Some have a one time deductible and some do not.

Typically coverage is based on the following categories:
Preventative; cleanings, exams, x-rays, etc.– 100%
Basic Restorative; fillings, some periodontal & oral Surgeon services, etc. – 80%
Major Restorative; crowns, bridges, implants, more major periodontal & oral Surgery, etc.) – 50%
*This is based upon the insurance company’s fee schedule

What most people are traditionally used to is not paying up front, the insurance pays what they pay, and then the patient receives a bill for the remainder of the balance. At Medicine Wheel Dental we collect payment when a service is rendered, we then submit to dental insurance companies who pay based on the same tiered system. This payment goes to the patient directly, and at the end of the year the patient still receives their $1,000 – $1,500 as a capped benefit regardless of how much dental work they had for that year.

The reality is, patients receive the same capped annual coverage as they do with an “in network” dental office.
Medicine Wheel Dental has invested into a state of the art insurance submission service so that our clients with out of network dental insurance benefits receive the insurance company’s reimbursement within the shortest amount of time currently available without compromising the level of care we can offer.
It is for the reasons above that Medicine Wheel Dental feels that this system is a “win, win” We do understand that dental insurance protocols, terminology, and coding can be a complex and time consuming process. Because your time is important to us, we are happy to offer the service of insurance submission and follow up at no additional charge to you.
One of our little ways of saying THANK YOU to all of our friends at Medicine Wheel.

“Don’t wait; utilize this year’s dental insurance coverage today.
Most policies renew January first and schedules are filling up quickly”