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What is a capitation plan? How is it different from dental insurance? With a "capitation plan" patients must sign up with the office they wish too attend. The most impotrant thing about capitation plans: They do not pay for any dental services. Under a capitation plan- depending on the condition and the treatment- patients are eligible for either no charge or a reduced fee for the services (whereas with conventional plans patients receive a service, the insurance remits a portion of that service, and any remaining balance is due by the patient). Your insurance may have informed you that for certain procedures you have a "co-pay", but the accurate term is "deeply discounted fee". How It Works Each month your insurance remits the office with a singular monthly "capitation fee". The capitation fee is compensation to the office not for any treatment, but for time spent in the office. Your capitation company determines the fee for how much time you are allotted to an office. For instance: If the capitation plan remits the office an amount reflecting 15 minutes of time a paitient is alotted to spend in the office, it doesn't matter whether that time is used for a consultation or having a procedure done, or anything else. Capitation plans do not remit for any treatment. All treatment fees- the deep discount fees- are due by the member. In accepting these deep discounts the office must exercise certain polices. Payment for services is due at the time of visit or an automatic late fee is assessed (this is regardless of coverage type). Capitation plans greatly limit the degree of latitude we can extend to members that cancel on short notice. To help you avoid a cancellation fee please leave us sufficient contact information (home, cell, and work phone numbers, e-mail addresses, and numbers of any spouses, parents, or guardians). We usually give a courtesy reminder call a day before your appointment. Services that are eligible for a discount In general when there is dental disease (i.e. prophylactic condition- i.e. cavities, a dental infection, etc.) patients are eligible for a deep discount compared to the normal office fee. The treatment that is eligible is the least costliest to remedy the condition. For instance, if you are missing some teeth and you don't already have an existing in-tact prosthesis, you are eligible for a discount for fabrication of a removable partial denture. If your preference is to have a prosthesis that stays permanently in the mouth (a fixed prosthesis- i.e. bridge or dental implant) the procedure can be done, but isn't eligible for a discount. If you forgo an eligible procedure you are considered electing to undergo more comprehensive treatment. How capitation plans function for patients Though we voluntarily participate with some capitation plans, we do not work at their dictation. Like dental insurance, the role of plans is to reduce the cost of dental services. Unlike dental insurance, they do not pay for any services. Unfortunately not all services are covered for a discount (i.e. code D0350- Digital images, D4265- material for healing of the socket of an extracted tooth). Any questions, concerns, or considerations as to why certain procedures aren't covered should be addressed to the insurance company. Please review the office section on "The First Appointment (click here)". The office follows ADA standards and the standards of the profession. There are parts of the exam that are not covered by insurance, notably the intra-oral camera survey and the annual oral cancer screening. These services are non-optional and must be done for any initial or check-up exam. Please be advised the office does not cut corners because insurance companies don't cover certain parts. (see "Minimal Diagonsitc Procedures"). Where treatment is concerned the office will do its best to present your options so you can select the one that suits you best. This office uses laser technology, and there is a laser fee for certain procedures where applicable. Hopefully this narrative gives you a better understanding of your plan. The office does sympathize when patients decline superior treatment in lieu of costs and insurance considerations. Furthermore we always look for solutions to help patients get the treatment they need. To that end we look forward to treating you and hope you find your experience here to be a positive one. |