Dennis R. Krug D.D.S.
Cottage Dental Care, LLC
Physical: 2206 Cottage Ave., Bloomington, Illinois 61701
Mailing: P.O. Box 385, Normal, Illinois 61761
June 18, 2012 REVISED
To Our Patients who work for the State of Illinois,
As you know by now, your dental insurance company has changed from Comp Benefits to Delta Dental of Illinois. We would like to address questions you may have about this change or correspondence you have received from Delta Dental or the State of Illinois’ website regarding this change.
First and as stated to you by your plan, your coverage and benefits have NOT changed. We are an Out-of-Network dental office. However, in our opinion, the language Delta Dental has chosen to use makes it seem as though you may need to change dental offices in order to reduce your out of pocket expenses and the cost to you. This is not necessarily accurate as described herein.
You will continue to have the same premium, deductible and yearly maximum benefits regardless of whether you choose an In-Network or Out-of-Network dental provider. Likewise, your deductible is still not applied to preventative and diagnostic services (“cleaning and exams”).
In addition, our fees for most services are lower than the benefit actually paid under the plan. For example, on a cleaning and exam, our “cleaning” (ADA code #1110) fee is $74. Your insurance benefit is $78. We have listed more examples for you in the chart below where our fees are less than the actual insurance benefit whether In-Network or Out-of-Network.
|Service & ADA Code
|Periodic Exam #0120
|4 Bitewing X-rays #0274
|2-Surface Posterior Resin Based Composite #2392
*Refer to Note
|Molar Root Canal #3330
*Refer to Note
*Note: Patient Responsibility is $0 after your deductible has been met. The same deductible is applied whether the dentist is In-Network or Out-of-Network.
We do have a few fees that are in excess of the insurance benefit. For example, dentures and crowns maximum benefit paid by insurance is less than our fees. Our fee for a porcelain fused to metal crown is $850.00, your insurance benefit is $716.00. Insurance applies your deductible of $125.00 to the $716.00 maximum benefit. $716.00 minus $125.00 equals $591.00 that insurance will pay of the $850.00. Your portion of out of pocket expense would then be $850.00 minus $591.00 equaling $259.00. Once you have met your deductible or if you have already met your deductible, your out of pocket expense for a porcelain fused to metal crown would be $134.00, $850.00 minus $716.00. Insurance calculates your benefit the same at any office regardless if the dentist is in network or out of network. You, the patient, will need to pay the difference between the office fee and your insurance benefit.
Furthermore, our office will still continue to submit your dental insurance claims for you in the same manner that we did before. The difference now is that the insurance check will go directly to you. You will then in turn be required to send payment to us or endorse the benefit check to our office to pay for the services. Our office extends the courtesy to wait for insurance to pay on services, which at the present time takes up to 9 months, rather than make you pay at the time of service and have you wait to be reimbursed by insurance.
Importantly, you will be assured to continue to receive the same quality level of dental treatment and services that you have received at our practice through the years; and in most instances, you will not incur any additional out of pocket expenses than if you visited a new In-Network dentist. If you have any further questions, please feel free to contact our office and speak with one of the front office staff.
The Office of Dennis R. Krug, D.D.S., Cottage Dental Care, LLC