DENTAL INSURANCE BENEFITS
Your insurance claim will be filed immediately, providing we have received all of your insurance information. It is very important you are aware of the limitations of your insurance plan.
All preventative and basic procedures will be considered under your insurance percentages. All major work must be paid in full before final placement of the completed product. We will collect the deductible and estimated amount insurance is not expected to pay the day of your appointment.
We file all claims electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after insurance has contributed their amount. If you have not paid your balance within 60 days a re-billing fee will be added to your account each month until paid.
We can only assist you in estimating your portion of the cost of treatment. Your Dental insurance is meant to be an aid in receiving dental care. They determine how your claim is handled and for what benefits they pay for. We cannot guarantee what your insurance will or will not do with each claim.
FYI #1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Many patients think that their insurance pays 90 to 100% of all dental fees, which is not the case. Most plans only pay between 50-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.
FYI #2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (UCR) used by the company.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for certain service. This can be very misleading and simply is not accurate. Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR fee. Frequently, this data can be three or fives years old and the allowable fees are set by the insurance company so they can make a net of 20- 30% profit.
Unfortunately, insurance companies imply that your dentist is overcharging rather than say they are underpaying or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary or reasonable UCR figure.
Before any treatment is started we make it possible to discuss fees and payment options. We work hard to make dental care affordable and to make sure that you are aware of your insurance benefits.
TREATMENT ESTIMATES
When a treatment plan is presented, and our patients wish to have some idea of what the investment will be, we can prepare an estimate of your planned treatment and request a pre-treatment work up from your insurance carrier.
