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Financial / Insurance

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We are happy to file insurance claims on your behalf! Navigating insurance benefits, coinsurance provisions, deductibles, conditions and co pays can be very confusing. After receiving all your insurance information we can estimate your financial portion of the dental service fee and ensure you receive the maximum benefits to which you are entitled. We cannot guarantee what your insurance company will pay on the claim.

Please understand that filing your claims is a courtesy our office provides and does not guarantee payment to us. Therefore, you are ultimately responsible financially for the services rendered.

If you have any questions about your insurance plan, please contact your insurance company directly.

Facts Concerning Dental Insurance

  • Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
    Dental insurance is meant to be a financial aid to dental care. Many people assume that their insurance pays 90%-100% of all dental fees. Unfortunately, this is not true.  Some plans 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.

  • Fact 2 - 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.

  • Fact 3 - INSURANCE 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.

2_resized.jpgInsurance companies set their own fee 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 outdated and these "allowable" fees are set by the insurance company so they can make a net 20%-30% profit.

Statements such as the one given above make 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 simply is not accurate. Unfortunately, insurance companies imply that your dentist is "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable figure.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.