Insurance FAQ
PPO and DMOInsurance Plans
If you belong to a traditional insurance plan we can assist you by filing your insurance claim. Traditional insurance is typically one in which you can choose any dentist you desire. Our practice does not belong to any PPO or DMO insurance plans.
If you are not sure what type of plan you have, we will be happy to assist in obtaining your information and explaining your benefits to the best of our ability.
In an effort to provide high quality dental care and to clarify our position on filing for your insurance benefits, we would like to share some facts about dental insurance with you:
- Your dental insurance is based on a contract between your employer and the insurance company. While we will attempt to estimate your dental benefits to the best of our ability, this is an estimate ONLY, and should not be depended on as the final decision. Should questions arise, it is best to contact your insurance company directly.
- You may receive notification from your insurance company stating dental fees are "higher than usual and customary". An insurance company surveys a geographic area, calculates an average fee and then takes that fee and considers it customary. Included in this survey are discount clinics and managed care facilities, which bring down the average. Most doctors in private practice will have fees, which are defined as "above usual and customary".
- Many plans tell participants they will be covered "up to 80% or up to 100%" but do not clearly specify plan fee schedule allowances, annual maximums or limitations. Insurance companies do NOT cover all dental services.
Why Can’t I Find Your Name On My List? We are occasionally asked why we don’t participate in a particular insurance plan, or if we would begin to participate in a plan that is cheaper for the patient to purchase.
We do not participate in any plan that would encourage a more ‘retail’ philosophy of practice. Dentistry is a service, not a product. For those plans where a filling is a filling and a crown is a crown, it’s always possible to find a cheaper way. For us, the manner in which that service is provided and the attention to details makes all the difference. We do not participate in plans that require us to discount our treatment and encourage us to make up the difference in volume. Nor will we make a practice of charging patients different fees for identical services depending on which insurance plan, if any, they belong to. There is enough diversity in today’s dental marketplace for everyone to find a practice whose values they share. We welcome everyone who is interested in quality dental care provided in a friendly, professional environment.
More Information
Phone: 704.332.6200
Email: info@drtomfarley.com