If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. Our office is a “fee for service” dental practice. This means that at the time of service the patient pays the “estimated” portion based on your insurances verification of benefits. You should be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. 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 30 days, whether insurance has paid or not. We will be glad to send a refund to you if your insurance pays us after that time.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only 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. Once again, we file claims as a courtesy to you. We appreciate your understanding of the limitations we are provided by your insurance company. Our goal is to give your child the best quality of care and service that they deserve. We are always happy to request a pre-determination for any dental treatment from your insurance company. MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
A Brief Description of How Dental Insurance Works
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.
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.
DEDUCTIBLES, CO-PAYMENTS & LIMITS MUST BE CONSIDERED
Insurance plans also have deductibles and yearly limits. Your deductible is determined by your insurance plan and will be an amount of money you must pay before your insurance starts paying. For instance, your deductible may be $50 for a year so the first $50 of dental charges in a calendar year are your responsibility and then the dental insurance will begin paying on the normal benefits for the rest of that year. Most insurance plans have a maximum of $1,000 or $,1500 that they will pay in a year. If a patient has a large treatment plan that costs more that this yearly limit then any charges over the yearly limit would be the patient’s responsibility.
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150. Assuming that the insurance company allows $150 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. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100 or $80. Out of a $150 fee they will pay an estimated $80 leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays only at 50% then the insurance benefits will also be significantly less.
As a courtesy to our patients we will accept assignment of benefits from your insurance carrier (many Delta Dental plans do not allow this), if you allow this, which means that we will accept payment from your insurance carrier and ask that you only pay your estimated portion at the time of the appointment. Our dental software will estimate how much your dental insurance is expected to pay and all that we ask is that you pay the rest. Please note that our software is only estimate of how much your insurance will pay and it is your responsibility to be aware of what you dental benefits are. For example, if your charge is $100 and our computer system estimates that your insurance will pay $60 then we would ask that you pay $40 at the time of service. If you insurance instead comes back and only paid $50 then you would still have a $10 balance on your account. If you have any questions about the above explanations, please do not hesitate to ask.
Financing Your Care
In our office, we offer high quality care and payment options for all of our patients. Below you will find a list of some of the common insurance plans we help process and payments that we accept. If you don’t see your plan on our list, please call our office to find out if we can process it for you.
Dental insurance plans we work with:
- Cigna Dental
- Delta Dental
- Medical Mutual
- Mutual Health Services
- United Concordia
- United Healthcare/DBP
- Cash, Check or Credit Card: Always accepted.
Please note: Payment is due at the time of service.
As a courtesy to you, we will bill your insurance company and track claims. Please keep us informed of any changes to your insurance plan. You are responsible for the fees charged by our office, no matter what your insurance coverage may be. Most insurance companies should respond to the claim within 30 days. Any remaining cost is your responsibility.
We are here to help! Please call for information about financing your child’s oral health needs in our office!