Insurance
& Financial Plans
Our mission is to deliver the finest, most affordable dental treatments available today.
Service Fees
West Wind Dental strives to ensure that our fees are fair and competitive by regularly comparing them to national dental fee averages. Copays and payments are collected at the time of treatment and we file the related claims with your dental insurance provider immediately.
For patient convenience, we accept multiple forms of payment including cash, personal check, Care-Credit, Visa, Mastercard, American Express. Additionally, financing arrangements may be set up to fit your individual needs by extending payment over a period of time.
Insurance
If all of your insurance information is received before your appointment, our team will be happy to file an insurance claim for you. While our professionals are committed to getting patients reimbursed through their dental carrier, ultimately it is up to the patient to understand differences between medical and dental insurance in addition to the specifics of their policy. You will be expected to pay for services rendered if the office is unable to verify your insurance information prior to treatment.
West Wind Dental is Out-of-Network With My Dental Insurance
What Does That Mean for Me?
One of the first steps in understanding how going to an out-of-network dentist will affect you is to first understand the difference between in-network (participating) and out-of-network (non-participating) providers.
Participating Providers (In-Network)
Participating in an insurance network means that your dental provider agrees to accept assignments for all services provided to the insurance members. By accepting an assignment, the provider agrees to accept the
amount approved (allowable) by the insurance company as the total payment for covered services. The deductible and/or co-insurance are applied to covered services and the member is responsible for these amounts.
A provider becomes a participating dentist through a credentialing process meaning that they sign a contract to accept the terms for treating their members. This contract includes an agreement to charge specified fees (allowable) for the services they provide, determined by the insurance company. The contracted fee does not cover the provider’s full fee for the services provided, but because the provider is in-network, they agree to waive or “write off” the additional cost, and patient is not responsible to pay it.
For example, let’s say that your provider is in-network with ACME Dental Insurance. ACME can dictate that while the provider’s fee for a Panoramic X-ray may be $125.00, the provider can only charge patients with ACME Insurance $80.00, which is their allowable, also known as UCR (usual, customary, and reasonable). The difference between the two fees (125-80=45), in this case $45.00, will be waived/written off by the in-network provider, and will not be the patient’s responsibility to pay. The insurance company will then pay a percentage of the allowable, based on the patient’s individual plan coverage. In the example listed above, if the patient has 100% coverage for X-rays, the insurance company would pay 100% of their allowable, which would be $80.00, and the patient would not have an out-of-pocket cost.
Most in-network dental insurance companies request that providers submit insurance claims with their full fee listed on the claim form. The provider understands that when the claim is processed by the insurance company, they will accept the allowable amount payable by the insurance company, and will agree not to charge the patient the difference.
Non-Participating Providers (Out-of-Network)
Going out of network with an insurance company means that your dentist is not bound by a contract to a patient’s insurance company, and therefore does not need to agree to the allowable/approved amount dictated by the insurance company. An out of network provider may then charge their full fee for all services they provide to their patients. The insurance company, in turn, will pay up to their allowable (based on the individual patient’s coverage/plan) for services rendered, and the patient is responsible for the remainder.
To simplify things, we will use the same example as above where the provider’s fee for a Panoramic X-ray is $125.00, and the allowable for ACME Dental Insurance is $80.00. The difference in this case is that the dentist is no longer required to write off the difference between their full fee and the insurance allowable. The insurance company will then pay a percentage of the allowable, based on the patient’s individual plan coverage. In this example, if the patient has 100% coverage for X-rays, the insurance company would pay 100% of their allowable, which would be $80.00, and then the patient would be responsible for the $45.00 difference between the provider’s fee and the allowable (125-80=45).
*It is important to note that there are multiple insurance companies that we are out-of-network with that have their allowables set to be in line with what our full fees are. When this happens, there is little to no difference in out-of-pocket cost for the patient, assuming that your percentage of coverage remains the same.
In some cases, a patient’s insurance plan will dictate that a patient can only go to an in-network provider or they will either pay at a lower percentage or will not cover any services completed by the out of network provider, however, this is not the norm. In order to know for sure how your insurance coverage will be impacted, it is best to call your insurance company and ask “how would my coverage be impacted if I see an out of network provider?” Unfortunately, most insurance companies will only give this information directly to the patient, and not to the provider, so this is not something we can determine for you.
It is very possible that once your insurance company is aware of our out of network status, they will contact you and give the impression that you are not able to continue being a patient here-this is often just a tactic to scare patients into only seeing an in-network provider, resulting in the insurance paying out less for your covered services and thus increasing their own salaries in the process. Please be assured that unless your individual policy stipulates that you must go to an in-network provider, West Wind Dental is able to continue seeing patients with out-of-network insurance.
In some instances, insurance companies will no longer send payments for your services to your out-of-network provider, and will only send the payments directly to the subscriber of the insurance policy, making it necessary for our office to collect our full fee from the patient at time of service. The patient will then be “reimbursed” for the amount that insurance covers when they receive their check in the mail from the insurance company. This will vary from one insurance company to the next, so it is important that patients verify if this applies to their policy or not.
Why has my dentist chosen to be a non-participating provider?
Our goal at West Wind Dental is to take care of our patients by providing the best care possible. Being in- network with an insurance company limits our ability to do this by dictating what types of services can or cannot be done and when. These restrictions may not be in the best interest of the patient. In addition, the insurance companies are requiring our providers to write-off or waive large percentages of their fees, making it that much more difficult to bring our patients the care that they deserve. In many cases, the average write-offs dictated by the insurance companies can be as high as 30-50% of the provider’s fee. Our costs for doing business continue to rise, but the insurance companies are not raising their reimbursement rates to match the inflation of our costs, resulting in some cases, for us to be doing our high-quality dentistry for free.
Making this decision was difficult as we do understand this may mean that some of our valued patients may choose to find a dentist who is in-network with their insurance. However, we could not in good conscious continue to allow the insurance companies to dictate what care is best for our patients. While we will certainly understand if the best decision for you and your family is to find another provider, we sincerely hope that you will give us the opportunity to continue caring for your dental needs here at West Wind Dental.