It is one of the most common calls our front desk gets. Someone new to the area, or newly covered through an employer, checks a plan directory, sees that Vestal Dental Associates is not listed as in network, and calls to ask whether we accept their insurance.
The honest answer is more useful than a yes or a no. We submit claims to every major dental insurance carrier, and most patients with dental coverage use it here. What we have chosen not to do is sign participating provider agreements that let an insurance company set the terms of your treatment.
Those are two very different things, and the difference is worth understanding before you assume your benefits will not work at the practice you want to see. This is also the right time of year to sort it out, since most dental plans reset on January 1.
Insurance directories are written from the insurer's perspective, and the language they use tends to collapse a real distinction. A practice that is out of network is not outside your plan. It is simply a practice that has not agreed to a contracted fee schedule.
Your benefits still exist. Claims still get submitted. The plan still pays according to its terms.
Many dental plans, particularly PPO plans offered through larger employers, provide out of network coverage that is comparable to or identical to their in network coverage. Others pay a somewhat lower percentage. The only way to know which situation applies to you is to look at your specific plan, which is something we are glad to do with you rather than leave you to guess.
Staying out of network is a deliberate choice, and it comes down to who decides what treatment you receive.
When a practice signs on to a contracted fee schedule, it agrees to be paid substantially less for each procedure. Practices absorb that in different ways, and the pressure it creates is well documented in the profession: seeing more patients per day, shortening appointment times, or letting coverage rather than clinical judgment shape a recommendation.
We would rather not operate under that pressure. Our practice has no quota to meet and no incentive to recommend a procedure because a plan happens to pay for it, or to leave something out because it does not. Treatment decisions are made between you and your dentist, based on what your mouth actually needs. Nothing more, and nothing less.
That approach is the reason we can spend the time we do on a thorough preventive exam, and the reason our doctors can take the comprehensive medical approach that has defined this practice since 1955.
Being out of network does not mean you are on your own with the paperwork. Our team handles the insurance side for you.
If you would like a straight comparison, we are happy to complete an exam and give you a written treatment plan you can take anywhere. If you then choose a managed care office, you will at least be comparing the same recommended treatment rather than two different opinions.
Almost every dental plan runs on a calendar year and includes an annual maximum, commonly somewhere between one and two thousand dollars. Whatever portion of that you have not used by December 31 does not carry forward. It is simply gone.
Three things typically go unused, and fall is when to look at them:
Your annual maximum. If you have had only routine cleanings this year, most of your benefit is still sitting there. If you have needed significant work, you may have already hit your ceiling, in which case scheduling remaining treatment in January makes better financial sense. Either way, knowing which situation you are in is the point.
Your deductible. If you have already met it this year, additional treatment before December 31 is covered at a better effective rate than the same treatment in January, when you start over.
Your FSA balance. Flexible spending accounts are use it or lose it money you have already earned and set aside. Dental treatment is an eligible expense, and unspent balances usually expire at year end or shortly after.
This is a good moment to schedule any treatment you have been putting off, whether that is a CEREC single visit crown on a cracked tooth, a consultation about dental implants, or a cleaning you never got around to booking.
No plan covers everything, and these options are available to every patient, insured or not.
We offer a professional courtesy for payment in full, an in office installment payment plan, third party installment plans through Cherry, and financing through CareCredit. We accept major credit cards, cash, and checks, and we offer online bill pay for convenience. Full details are listed on our payment and financing options page.
The goal is simple: cost should determine when you get treatment, not whether you get it.
If an insurance directory told you we do not take your plan, call us before you take that at face value. It costs nothing to have someone who reads these plans daily look at yours, and a fair number of patients are pleasantly surprised.
Call Vestal Dental Associates at (607) 785-3339 and ask for our insurance coordinator, or request an appointment at our Vestal NY office. If you are considering becoming a new patient, we will walk you through your coverage and your options before any treatment is scheduled.
We have been doing this in the same community since 1955, and you can read what our patients say about that experience. There is never any pressure. Just clear information, so you can decide what makes sense for your family.