We file almost all dental insurances and our office participates with Delta Dental Premier. We will estimate your portion of payment at the initial visit and expect your portion at the operative (fillings, crowns, dentures, etc.) appointment. As a courtesy, if you bring all insurance information to the initial visit, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay.
Please understand that we file dental insurance claims as a courtesy to our patients. We do not have a contract with your insurance company, only you and your employer do. We are not responsible for what benefits they pay on a claim, we can only assist you in estimating your portion of the cost of treatment. We cannot be responsible for any errors in filing your claim. Our staff will be happy to assist you in answering questions regarding your dental insurance.
NO DENTAL INSURANCE PAYS for 100% OF PROCEDURES. Dental insurance is an aid to receiving dental care. Most plans pay 50-80% of the average total fee. The amount 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.
BENEFITS ARE NOT DETERMINED BY OUR OFFICE. You may notice that 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 fees have exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. A statement such as this implies that any fee greater than that reimbursed is unreasonable or well above the industry standard. This is very misleading and inaccurate. Insurance companies set their own fees based on fee information from claims it processes and each insurance company has different fees they consider allowable. Frequently, these allowable fees may not be up to date and are variable based on the type/cost of the plan chosen. Unfortunately, this implies that the dentist is overcharging instead of the insurance company underpaying. In general, the less expensive the dental coverage, the lower the UCR fees will be.
DEDUCTIBLES AND CO-PAYMENTS MUST BE CONSIDERED. When estimating dental benefits, it is important to consider deductibles and percentages (co-payments). For example, assume a fee for service is $150.00. Assuming the insurance company allows $150.00 as its usual and customary fee (UCR), we can calculate the amount you will owe. First, we need to meet the deductible. The average for this is $50, which must be paid by you before insurance benefits will begin. This leaves $100. If this particular service is covered by your insurance at 80%, your insurance will cover $80 of this fee. This means you will pay $70 and the insurance will pay $80. This amount will change if UCR, deductible or co-payment percentage changes.
It is very important that you update our office of any insurance changes. This will expedite processing of your claim and allow us to estimate your charges appropriately.
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