Our office is committed to helping you maximize your insurance benefits.
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.
You must 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. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if your insurance pays us.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients.
We do not have the 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. Any estimate give is just that, an estimate. It is NOT a guarantee of payment. We at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.
INSURANCE DOES NOT PAY 100% OF ALL TREATMENT
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 DETERMINED BY YOUR INSURANCE COMPANY, NOT OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you/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 not accurate. Insurance companies set their own fee schedules, and each company uses a different set of fees they consider allowable. These allowable fees vary widely, because each company collects fee information from claims it processes. The insurance company then takes the data and arbitrarily chooses what they deem an “allowable UCR” fee. This data is often up to 5 years old, and fees are set so that the insurance company can maintain a significant net profit (often 20%-30%).
Unfortunately, insurance companies imply that your dentist is over charging, rather than to say they are under paying, or that their benefits are low. Most of the time, the less expensive your policy is, the lower UCR fee schedule they will use to determine payment.
DEDUCTIBLES AND CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages of coverage must be considered. If they cover 50% of a procedure instead of 80%, they will pay significantly less, and the patient portion will be more. Patients are always responsible for their deductible, which is applied differently by each individual insurance plan or contract.
At all times, you can be confident that we will always provide you with our best services without regard to the limitations imposed by your insurance coverage. To do otherwise would violate our contract with you.
If you have any questions, our front office staff will be glad to assist you.