Our Office Policy Regarding Dental Insurance
If we have received all of your insurance information before the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we 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 most insurance claims 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.
PLEASE UNDERSTAND that we file dental insurance claims 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. There are many different insurance plans and each may contain limitations and exclusions to the plan that we are unaware of. We also can not be responsible for any error in filing your insurance. Once again, we file claims as a courtesy to you.
Dr. Dan accepts most insurance including Delta Dental, Superior Dental, Dental Care Plus Group, CIGNA and GEHA/Guardian.
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 the 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 impressions 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.
Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may very 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 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 AND CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. As an example, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual, customary, or reasonable (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 pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Therefore, 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 benefit will be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as insurance carrier name, address, phone number as well as any change in employment.
WHAT ABOUT FINANCES?
Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives you the best possible care. We accept cash, personal checks, debit cards and Visa, MasterCard and Discover.