Quote:
Originally Posted by blackscholes
I have Delta Dental and I requested an estimate for a dental implant.
The dental office submitted a fee of $1500. However, my insurance company does not cover this service but they said that the accepted fee is $800 because my dentist is a participating PPO provider. In other words, even though insurance does not cover this service, I would only be responsible for $800 because that is the negotiated rate.
Is this correct? Am I only responsible for $800 even though insurance doesn't cover this. I just want to make sure before I agree to the services. Is this how it works?
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I have Delta too. And yes that's how it works. Your dental office is a participating provider, and therefore abides by the "schedule of fees" that Delta contracts them for. In other words, the price is part of a contract that Delta has with the dentist. In exchange for the lower price, your dentist gets to be listed with Delta as a participating provider - which in turn brings him a lot more customers than if he wasn't a participating provider. So his profit -margin- is lower per-patient - but his net profit will be the same or higher. He makes up in volume what he doesn't make in fees.
As an FYI: that's a really great price for an implant. I mean significantly really great, awesome and stupdendous. I'm assuming this does -not- include the price of bone grafting. If it doesn't, make sure you find out what that fee is, and have the dentist submit it as well. If it's an implant on the lower jaw, it's possible that you won't need grafting at all. Upper jaws tend to need it, because the tip of the implant is very close to where the sinuses are. Not everyone needs grafting on the upper jaw, but it's pretty common.
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