Our Office Policy Regarding Dental Insurance
If we have received all of your insurance information by the day of the appointment including ID and group number, 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. We file all insurance so your insurance company will receive each claim within the days of the treatment. You are responsible for any balance on your account after treatment is over, whether insurance has paid or not. If the balance has not been paid within 60 days, accounts are turned over to the firm of Legal Liaison services LLS for collections. We will be glad to send a refund to you once insurance has paid us.
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 company 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 Payments for Dental Procedures
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% to 100% of all dental fees. This is not true! Most plans only pay between 50% to 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. There are literally thousands of contracts available for employers to choose from.
Determination of Benefits
Your dental insurance benefits are not determined at all by your dentist. 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 takes this data and arbitrarily chooses a level they cal the “allowable” UCR Fee. Frequently this data can be three to five years old and the insurance company sets the “allowable” fees so they can make a net 20% to 30% profit. 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 not accurate.