We welcome all traditional dental insurance that allows you to go to the dentist of your choice, since we will be considered out-of-network. We ask that you be familiar with your insurance benefits. PLEASE UNDERSTAND that your insurance is a contract between you and the insurance company and our fees may be in excess of the Usual, Customary, and Reasonable (UCR) determined by your insurance company. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim.
We at no time guarantee what your insurance will or will not pay on each claim, and will do our best to estimate the amount you will owe. Any fees not covered by your dental plan, deductibles and estimated co-payments will be the sole responsibility of the patient and will be due at the time services are rendered. In the event that your insurance does not pay the amount we have estimated we will send you a statement that will be due within 10 days.
As a courtesy to you, we will file your primary insurance claims and assist you in every way we can, however can not guarantee payment from your insurance company. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 60 days, whether insurance has paid or not. If your insurance company denies your claim for any reason it is your responsibility to pay the denied amounts in full.
Sometimes your insurance company will refuse payment of a claim for some of the following reasons:
- This is a condition that they do not cover.
- You have not met your deductible.
- The type of dental service required is not covered.
- The insurance was not in effect at the time of service.
- You have exceeded your maximum dollar amount or visits allowed.
Fact #1: NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! 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.
Fact #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 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 to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.
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 (UCR) figure.
Fact #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.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment. Failure to do so could mean the claim may be denied. This protects you from paying a bill because we had the wrong insurance information.
If you have any questions about your insurance coverage or our office procedures, please contact Lisa at (817) 465-0355 or email@example.com.