Welcome to Michael S. Micheff & Associates:
Please take a few minutes to read the following information about what I’m able to offer you as a prospective, new or existing client. I bring you over 40 years of experience in the sales and service of Dental Insurance.
I am available for telephone or website assistance for an explanation, proper usage of provider finders, and the purchase of Dental Insurance. My goal is to make you a well-educated client. I’ll demonstrate that as you read through my letter…
I represent the following insurance companies: Ameritas, Anthem, Blue Cross Blue Shield, Cigna, Delta Dental, Humana, IHC Group, Nationwide, and Renaissance. I’m licensed in the states of Arizona, Illinois, Michigan, South Carolina, and Wisconsin.
Dental insurance offers you coverage from cleanings to root canals. It can be difficult to predict how much money you’re going to spend for your dental care.
Dental insurance is designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: (1) Indemnity (generally called dental insurance) that allows you to see any dentist you want who accepts this type of coverage; (2) Preferred Provide Network dental plans (PPO); and (3) Dental Health Managed Organizations (DHMO) in which you are assigned or select an in-network dentist and/or in-network dental office and use the dental benefits in that network.
Generally dental offices have a fee schedule, or a list of prices for the dental services or procedures they offer. Dental insurance companies have similar fee schedules which are generally based on Usual and Customary dental services, an average of fees in your area. The fee schedule is commonly used as the transactional instrument between the insurance company, dental office and/or dentist, and the consumer.
Indemnity Dental Insurance Plan: This plan may be helpful when you want to stay with your dentist and he/she does not participate in a dental network. By the very nature of this plan the insurance company generally pays the dentist a percentage of your services according to the policy you purchased. In addition you will want to review the co-payment requirements, waiting periods, stated deductible, annual limitations, and graduated percentage scales based on the type of procedure and/or length of time you have owned the policy prior to starting your dental work.
Dental Health Maintenance Organization (DHMO): When a dentist signs a contract with a dental insurance company, that provider agrees to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods, no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of dental procedures. Some dental insurance plans offer free semi-annual preventative treatment. Fillings, crowns, implants and dentures may have various limitations.
Participating Provider Network (PPO). Depending on your specific plan, the PPO works similar to a DHMO while using an In-Network facility. However, it allows you to use an Out-of-Network or Non-Participating Provider. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified in your dental policy. As noted, some dental insurance plans may have an annual maximum benefit limit. Thus, once the annual maximum benefit is exhausted, any additional treatments may become the patient’s responsibility. Each year that annual maximum is reissued. The reissued date may vary as a calendar year, company fiscal year, or date of enrollment based on your specific plan.
Dental insurance companies divide benefits, services, or procedures into categories and refer to them with American Dental Association (ADA) 3-4 digit codes. As an example, Preventative and Diagnostic procedures often include exams (ADA code 0120), x-rays (ADA code 0210), and basic cleanings or prophylaxis (ADA code 1110). Basic procedures often include fillings, periodontics, endodontics, and oral surgery. Major procedures often are crowns, dentures, and implants. Procedures such as periodontics, endodontics, and oral surgery may fall into the Major category depending on your specific plan – with specific fee schedules and co-payments.
The enrollment process varies but often members are assigned an identification or policy number. When dental treatment is rendered, a claim for services is filed with the dental insurance company. Depending on the type of dental insurance policy you purchased, some claims processing is handled directly by the dental office.
Most Dentists accept and bill your Dental Insurance Company as a courtesy to you. Your dentist may not always be a contracted provider for your PPO or DHMO network. A non-network provider does not have to accept the same level of reimbursement from your insurance company, potentially resulting in back billing. You can take full advantage of your policy’s benefits without being back billed – when you only use a contracted network provider.
Perhaps you should start your search for Dental Insurance by first questioning your dentist as to what PPO or DHMO network they are contracted with. Then, select the insurance company that uses that network. If you don’t have a dentist, then pick a dental plan that best fits your needs and budget, and use one of their contracted providers.
All of the dental plans include preventative care. I encourage you to use this semi-annual benefit as you might just avoid those costly root canals, crowns, and gum disease surgeries.
Please call me to determine the best plan that is most suitable for you and your family. You can also check out my new and continuously developing websites:
https://einsureyourself.com
https://einsureyourself.net
which will securely link you to many of the major insurance companies for the online purchase of Individual Dental insurance. You will also be able to find out if your dentist is in any network through the provider finder links that I provide…
Keep Smiling!
Mike Micheff
“IN TOUCH WITH YOUR REAL INSURANCE NEEDS SINCE 1975”