The most common question our front desk gets is whether we take someone's insurance. The honest answer takes more than one word, so here is the whole thing in one place.
What in network actually means
When a dental office is in network, it has signed a contract with an insurance company agreeing to accept that company's fee for each procedure. The insurer gets a discount and lists the office in its directory. That is the whole arrangement.
The part patients rarely hear is what a practice has to do to make those fees work. Contracted rates are often well below the cost of the time and materials involved, which is usually made up in volume: shorter appointments, more of them, more work handed to assistants, cheaper labs. None of that is dishonest, but it does shape the dentistry.
Why we are not in any network
Dr. Ladhar has chosen not to sign those contracts, and that means our recommendations are not shaped by a fee schedule. When she needs an hour for something a contracted rate would fund for thirty minutes, she can take it. When a case needs a better lab, we use one.
It also means nobody here has to think about whether a plan will reimburse before saying what a tooth needs. You may still decide not to do it, and that is entirely your call, but you will hear the actual recommendation first.
Your PPO still works here
This is the part people get wrong most often. Out of network does not mean we cannot use your insurance. We accept every PPO plan, and Linda files the claim for you rather than handing you a form to post yourself. Most PPO plans pay a percentage of out-of-network care, and for preventive visits that percentage is frequently the same as it would be in network.
Where there is a difference, it is usually the gap between our fee and what your plan considers allowable, and you are responsible for that gap. We would rather you know the number in advance than discover it on a statement, so send us your plan details before your first visit and Linda will check your benefits and tell you what to expect.
What we cannot take
We do not accept HMO or DMO plans, because those plans only pay a dentist assigned to you from their own list, and we are not on it. We also do not accept medical insurance, including for sleep apnea appliances, even though some medical plans do cover them.
If an HMO is your only coverage, call us anyway. Sometimes there is a route worth discussing, and sometimes the honest answer is that you would be better off with a practice on your plan's list. We will tell you which, because wasting your time and money helps nobody.
If you have no insurance at all
A lot of our patients do not, and that is not a problem to solve at the front desk in a hurry. We have an in-office membership plan that covers your regular exams, cleanings, and x-rays for a flat annual fee, with a percentage off anything else. For many people it works out better than a policy would.
Beyond that, established patients can arrange payments here in the office with Anna, third-party financing is available to anyone at no extra cost to you, and patients 65 and over take five percent off treatment.
The short version
Bring your PPO plan and we will bill it for you and chase it when it stalls. Ask what something costs and you will get a number before you agree to it, not after. If you want your benefits checked before you ever sit in a chair, call (408) 252-5575, Monday through Thursday.
