Insurance

In Santa Fe, New Mexico

Robert L. Wartell, DDS
Kristine Berg Ali, DMD
Sandraluz Gonzales, RDH

About Insurance

Of the services we provide, some are covered by dental insurance, and some by medical insurance. In general, services to diagnose and treat sleep apnea and pain (except tooth or gum pain) are covered by medical insurance. There are always exceptions.

It is best if you remember two things about insurance: (1) the insurance companies increase profit by denying claims and (2) employers generally increase profit by selecting plans with lower premiums. Lower premiums means lower benefits for you.

Some information about dental insurance:

Dr. Kristine B. Ali is a participating provider for several dental insurance plans. This means that she charges you the fee that is allowed by your plan. You are responsible to pay any deductible and co-pay for the service, and your plan pays the remainder.

Dr. Robert L. Wartell is not a participating provider for any dental insurance plans, and his fees are higher than that allowed by most plans. He accepts payment on your behalf from most dental insurance companies, and you must pay the difference between the insurance allowance and his fees. We will do all we can to help you receive the maximum benefit to which you are entitled. For both doctors, you are responsible to pay us your deductible amount and any copay amounts at the time of service. You are also responsible to pay for any treatment that you have accepted that is not covered by insurance, and for any balance remaining after your insurance benefits have been received by us. We accept payment by cash, check, or major credit cards.

Some insurance companies will not send your benefit check to us directly. If that is the case with your insurance company, you must pay us for services as they are provided to you.

While dental insurance has been designed to assist you in paying for your dental care, it may not cover all of your treatment needs. Here are some facts that you should know about dental insurance:

Dental insurance is not meant to be a PAY-ALL. It is meant to be an aid. The same annual limits that were in place in the 1970s are still in place today. The annual maximum benefit usually ranges from $1,000 to $1,500.

The amount your plan pays is determined by how much your employer has chosen to pay for the plan.

Some plans tell their insured that they cover "up to 80%" or "up to 100%" but do not clearly specify the fee allowance, deductibles, or annual maximums. We have found that most plans cover about 35% to 65% of total treatment plans.

Many routine dental services are NOT covered by dental insurance.

Some services, such as treatment for Temporomandibular Disorders (TMJ), are covered by your medical insurance instead of your dental insurance.

Some information about medical insurance:

New Mexico requires that all insurance companies that do business in New Mexico must cover TMJ disorders, but some insurers try to weasel out of their obligation. If this happens to you, we will provide you with some resources to dispute a denial of benefits.

Some patients have been denied benefits for oral sleep apnea appliances, because Dr. Wartell is a dentist, not a physician. These stupid insurance company employees have to be told that ONLY dentists are licensed to provide oral appliances, which are considered a medical service.

We participate in only one medical plan -- Presbyterian Medical Services.

We do not participate in Medicare. If you are a Medicare recipient, the federal government says that you must sign an agreement with us that defines our financial relationship. You will not be reimbursed by Medicare for any fees we charge.

We will work with you to get the maximum possible benefit from your medical insurer, but your benefits may be limited by your plan, and not cover our entire fee.

Please call with any questions about your insurance.

We enjoy answering your questions. For more information,
please call us at 505-474-4644

Center For Dental Medicine • 2019 Galisteo St. • J2 • Santa Fe, NM 87505

(Behind Los Alamos National Bank, St. Michael's & Galisteo) Map

You may contact us by:
phone: 505-474-4644
Email Us
postal: 2019 Galisteo St., J2, Santa Fe, NM 87505