INSURANCE

The purpose of this page is to educate our patients in order to help us achieve our goal of maximizing our patients’ benefits without compromising care because of insurance restrictions
insurance n
  1. An arrangement by which a company gives customers financial protection against loss or harm in return for payment
There are many forms of insurance in our lives that fit the above definition well (medical, auto, homeowners, life, etc).  

​Dental insurance differs from these...

Non-Participating Provider 
Many of our patients DO HAVE dental insurance.  
Dr. Rumfola is considered a non-participating provider and has elected not to participate for a variety of reasons, including:
  1.     Participants agree to provide treatment as dictated by the insurance company, not according to how they have been trained, or their patients needs or best interests.
  2.     Participants agree to provide discount dentistry to patients with insurance in exchange for being listed by the insurance company.  The term preferred is misleading, because it implies that a participating dentist is somehow better than his non-participating colleague, when in reality, participants often make up for the discounted fee by increasing their patient volume (double booking, or spending less than ideal amounts of time to assure the highest quality care).
  3.     There aren’t many large employers in the area to make it worth signing on to a particular insurance, and it seems unfair to provide some patients with discounts and not others for the same procedures.
  4.     Big group practices that take all kinds of insurances usually have one or more employees dedicated to tracking down money.  We have a small staff, and adding another employee just for this purpose would unnecessarily raise our fees.
  5.     There is no insurance company endorsed by the American Dental Association other than direct reimbursement, which is a plan where all of the money invested into the plan goes toward dental treatment, and not to a third party.  Over the past several years, the ADA has actually sued several major dental insurance companies, which makes us hesitant to become involved with any.
  6.     Dental insurance reimbursement is based on a “usual, customary and reasonable fee schedule” which is determined by each insurance company and is not representative of the actual average fees of a dentist in private practice, since they do not provide special consideration for operating costs of  the average dentist versus a hospital dental clinic or managed care facility.

So what do we do for our patients with insurance?
• We work with our patients and their insurance companies so that they receive the treatment and reimbursement they deserve.
• Our practice is fee for service, so payment is due at the time treatment is given, unless special arrangements have been made in advance.  Insurance companies generally provide reimbursement within a couple of weeks to their subscribers, while it can take up to eight weeks for a dentist to receive payment.
• We submit all of the paperwork (pre-determinations, claim forms, x-rays, etc.) that the insurance company needs on the day of the office visit, as a courtesy to our patients.
• We are willing to stand in our patients’ corner if claims are disputed, and can speak to companies or provide narratives to help patients receive benefits.