Before we initiate any treatment, we work very hard to explain treatment options along with their advantages and disadvantages. Following that, we present to our patients the fees, as well as our estimate of how insurance may pay as well. In that way patients have an estimate of their out-of-pocket dental expense. While we work very hard to make these estimates accurate, dental offices at this time still cannot have instant access to the databases of individual insurance carriers for determination of benefits. As a result, we may only provide good faith estimates for which we cannot be held accountable. We do the best any dental practice can to provide accurate insurance information. The most common insurance carriers we work with include MetLife, Aetna, Cigna, and United Healthcare, amongst others.
We are happy to assist you by filing insurance claims and the necessary documentation for you. We have three different computer programs within our office that allow us to obtain the most accurate and up-to-date information that we can get. While we recognize that it would be nice to have no out-of-pocket expenses, most insurance carriers will not pay 100% of all charges. We are able to evaluate most insurance plans online to determine what is covered and at what percentages.
With thousands of different insurance policies, it may be difficult to predict exactly what portion of the dental fees the insurance carrier will pay and what portion the patient will pay. If we have received all of your insurance information on the day of your appointment, we will be happy to file the claim for you. We encourage you to be familiar with your benefits since we will collect from you the estimated amount your insurance carrier is not expected to pay. Your insurance carrier should pay each claim within 30 days of receipt. We file all insurance electronically so your insurance carrier will receive each claim within days of the treatment.
Please understand that we file dental insurance claims as a courtesy to our patients. We technically do not have a contract with your insurance company; only you do. Moreover, even PPO insurance plans offer valuable “out of network” benefits that can be used to pay for the services we provide. We sincerely are not responsible for how your insurance company handles its claims or for what benefits they may pay on a claim. We can only assist you in estimating your portion of the treatment fees and we are very pleased to assist you with that. We also can assist you by substantiating each claim by submitting large amounts of information to prove why the work was needed. As our patient you are responsible for any balance on your account. If you can appreciate the dedication we have to supporting you with your dental insurance plans from the time of determining eligibility and benefits to the time of collecting payments, we invite you to contact us.
No insurance carrier 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. Unfortunately, most all the time this is not true. Most plans only pay between 50%-80% of the average total fee. Some pay more and some pay less. The percentage paid is usually determined by how much you or your employer has paid for the coverage or by the type of contract your employer has set up with the insurance company. We encourage our patients to think more about their care than on their insurance plan. The mouths and teeth of our patients naturally belong to them. It is the patients who must live with their mouths and the care they receive. We invite our patients to consider making decisions on their dental care based on their desires and not on the limitations placed upon them by their respective dental plans. If you share in our philosophy that patients should take control of their dental care and should make decisions that are best for themselves, we invite you to contact us.
Benefits are not determined by our office
You may have noticed at times 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 misleading and simply may not be accurate. Insurance policies might imply that your dentist is “overcharging” rather than indicate that they are “underpaying” or that their benefits are relatively low. In general, the lesser expensive insurance policy will utilize a lower usual, customary, or reasonable (UCR) figure. An insurance company has a financial incentive in lowering its UCR payments to make additional profits. Our dental practice has an interest in providing superior care for our patients. We realize that excellent and honest care saves patients a large amount of time, effort, and money. If you can sense that we are patient-centered and are very concerned for their care, we invite you to contact us.
Deductibles and co-payments must be considered
When estimating dental benefits, deductibles and percentages must both 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 determine what benefits will be paid. First a deductible (paid by you), at an average of $50, is subtracted from the total fee, leaving $100.00. Then for instance the plan pays 80% for this particular procedure. The insurance carrier will then pay 80% of $100.00, or $80.00. As a result, out of a $150.00 fee the insurance carrier 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.
We recognize how confusing dental insurance can be for parents. We are happy to assist you to the best of our ability with your insurance concerns. We invite you to call us at (972) 250-2580 so we can assist you with your insurance concerns and with making an appointment.