David F Pascoe DDS MSD
(631) 765-1919

Insurance Coverage

Our number one priority is YOU. Our mission is to help you maintain and maximize your long-term dental health, comfort and function.

We do not accept assignment of insurance benefits because we are not prepared to compromise our standards of care or your health to enhance the bottom line of some corporation.

Insurance Policies

Insurance companies are in business to make a profit and not to provide you optimal health care. You as a patient can get back in benefits only what you and your employer put into the program, minus the profits.

Contracts with insurance companies are negotiated in advance of services.The companies pre-determine "usual and customary" fees for a given geographic area. These fees bear no relation to the expenses involved in providing services. They are the reason why many health care providers refuse to operate under captive plans. These contracts invariably contain obscure clauses and provisions which enable them to contain their costs. Because these vary so much between companies, we will pre-determine treatment plans as requested but cannot estimate reimbursements ourselves.

Insurance Claims

It is in the interest of the companies to delay claims as much as possible. To ensure that our patients realize that the delay is not in our office, we provide printed detailed pre-determinations and claims at the time of service for all patients. We take pride in the fact that all claims in our office are handled on a same day basis.

In the event of major reconstruction-type treatment, where possible we will "phase" the treatment over two or three years if necessary, to coincide with benefit years  and minimize your "out of pocket" share. We've been doing this for years, and we know the ins and outs. And we'll help you with your share by setting up a workable Budget Plan if you wish.

But please don't ask us to "fudge" treatment dates, or "write-off" your required co-pay share. Those maneuvers are fraudulent and unethical. They are also illegal.Remember-you can only get back from your insurance the contributions less the operational costs and profits to the insurance company.

Insurance companies are not charitable organizations. They are not in the business of caring for your health or good looks. They are not "objective" or "non-partisan". Their primary purpose is to make money. They make a profit by paying out the absolute minimum in benefits, often discouraging legitimate utilization.

 Your insurance:

  • Dental insurance is not meant to be a "Pay-All", it is only meant to assist you in payment for your dental care. Full coverage insurance would result in prohibitive premiums.
  • Many routine dental procedures are not covered by insurance plans, though they may be normal and necessary. The carrier may not cover the procedure to reduce costs or your company did not purchase that particular coverage, to reduce its costs. The terms of the plan coverage have nothing to do with what services you actually need. This is especially true for maintenance procedures the need for which varies tremendously between individuals.
  • Many plans state that you will be "covered" up to 50%, 80% or even 100%. In actuality many plans cover less than because of an an arbitrarily established "Usual & Customary" fee schedule. The benefits your plan pays are largely determined by the premiums. Dental insurance is similar to car or home insurance: you can buy a policy with no deductible or a large deductible, to cover all or only a variable portion of the actual repair or replacement cost.
  • An insurance company's established "Usual & Customary" fee schedule for a particular plan may or may not accurately reflect "real-world" fees for a given area. Each plan defines its own version of "Usual & Customary" fees.
  • Therefore different insurance plans will have different schedules for the same geographical area. A dentist's fee for a procedure could be well within one schedule-and not another. It is a common experience that some insurance companies tell their insured that "fees are above the Usual & Customary level", rather than tell the truththat "our benefits are lower than they should be". Most benefits and annual limits have not been adjusted for inflation over the past several years and subscribers are getting much less for their premium dollars than they used to

Insurance companies

  • Are not in business to provide you with optimal health care.
  • They are in business to make a profit for their shareholders.
  • They make a profit by paying out less than they take in.
  • Every denial, obstruction and technicality reduces your benefit and enhances their bottom line.