As a courtesy to our patients with dental benefit plans, we will submit necessary claim forms, receipts, and other information to your insurance company. Although we will gladly file a claim on your behalf, you may still wish to submit the claim yourself. In general, insurers process claims filed directly by patients faster than those filed by the service providers (dental offices).
Our insurance coordinators deal with many different insurance companies. Some companies offer many different dental and medical plans. These companies can change benefits, co-pays, and deductibles many times throughout the year. We do our best to provide you with accurate coverage estimates based on information available to us. At times, it is almost impossible to accurately estimate a patient’s insurance co-payment. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment.
Unfortunately we do not have a contract with your insurance company, only you do. We can do our best to assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. Further, most dental insurance policies are limited and often only pay for a portion of the procedure(s) that may need to be done.
Please provide us your insurance information prior to or on the day of the appointment. Also, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
IMPORTANT POINTS TO NOTE REGARDING DENTAL INSURANCE
1. NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Unfortunately, most plans only pay between 50%-80% of the average total fee. 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.
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 a certain service. This can be very misleading and 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 to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.
3. DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.