Our Office Policy Regarding Dental Insurance

Our office accepts most major insurance plans that allow you to choose your own dentist.  We do not accept any HMO plan since you have to be assigned to the plan's dentist.  Please call for help on your particular plan to maximize your dental benefits.  PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients.  We do not have a contract with your insurance company.  Your dental insurance is a relationship between you and 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 will gather your insurance benefits coverages with the information that you provide us.  An estimate of what your plan might cover will be provided to you.  As a courtesy to you, we will submit the claim for you.  You will be responsible for your estimated portion at the time of service.  Once we receive payment from your insurance company, any balance remaining will be your sole responsibility.  On the other hand, you will be issued a refund check if your benefits plan pays more than what was initially estimated for you. Dealing with insurances can be very challenging for us and for you as well!  If you have any further questions please contact our office.

Facts About Dental Insurance:

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.