Dental Insurance Information…In Network for Drs. Waltemath, Keenan, & Parkes
Dental insurance policies can be complicated, and the language is often confusing. Some policies allow the patient to go to any dentist, while others require the patient to go to a dentist on a restricted "in network" list. After reading this information, if you have further questions, please call Diana (insurance coordinator) in our office.
Dr. Waltemath, Dr. Keenan, and Dr. Parkes are "in network" for the following insurance companies:
BlueCross BlueShield of Tennessee
Cigna PPO
Delta Dental Premire Plan (not DPO or PPO)
Dental Health Alliance / Assurant / Aetna PPO
DNoA Preferred Network
GEHA/Connection Dental Network
Guardian PPO
HealthSpring Dental
TennCare for children under 21 yrs. old
United Concordia
If your insurance plan requires you to go to a dentist on an approved list, and that insurance company is not listed above, then you may not receive full dental benefits and possibly none at all from this practice. If your insurance plan allows you to go "out of network," we will file your claim and you will be responsible only for the non-covered portion of your bill. If you are unsure which type of plan you have, you may contact your benefits department, insurance company, or bring your card to our office.
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When learning about your dental plan, it is especially important to be aware of the following:
* Is there a waiting period for any of the benefits? We have several patients whose insurance will pay for filllings only after they have been enrolled for 12 months and for crowns after 24 months.
* What is the maximum for the year? Unlike medical insurance, dental insurance will pay only a certain amount each year and no more than that amount, regardless what treatment is needed.
* Is there a deductible and to which services does it apply?
* At what percentage will the insurance pay for cleanings? Fillings? Crowns?
* How often are cleanings allowed? There are three typical frequencies: 1 in 6 months, 2 per calendar year, and 2 in twelve months. While this sounds simple, failure to take note could cause a cleaning visit to be denied. Each patient should know how their insurance reads. If you don't know, you can call your insurance company and they can tell you.
* How often are crowns replaced?
* Is there a missing tooth clause that excludes procedures in the area of a tooth missing prior to coverage?
* Does insurance cover dental appliances such as occlusal or night guards?
It is also important to know that insurance almost never pays for purely cosmetic treatment and that your dentist does not decide which services will be covered and at what rate. In fact, an insurance company may lead the patient to believe that his or her dentist’s fees are too high, creating distrust between doctor and patient. In reality, the insurance companies have different fee schedules which result from the amount an employer or patient is willing to pay. They may claim to average the fees of several dentists in an area, but if that were the case, there would not be such a broad range of accepted fees. Some insurance plans accept every bit of our fees while others place the fees at a point that is laughably low.