Please understand that dental insurance will never cover all of your dental needs. Insurance is available to help with costs, up to some predetermined limit. Also understand that insurance companies do NOT have your dental health as their priority. They are in business to make a profit. They do this by collecting more then they pay out for you.
While we understand that getting your money back from the insurance company is important, we never loose site of our first priority - your dental health. For this reason, we do not allow insurance companies to dictate care to us. You as the patient decide what is best for you and then proceed with care.
We work with most dental insurance companies. However, we are not part of any Preferred Provider, DMO or HMO plan. Most Preferred Provider plans allow you to choose your own dentist. DMO and HMO plans require that you go to a dentist on their list, but they may pay some "out of network" benefits if you see a dentist who is not on their list.
We will do our best to maximize your benefits. We will complete your claim forms, including narrative reports, and copies of x-rays and photos.
The range of benefits depends solely on what your employer negotiates with the insurance company. Some plans may not cover your dental treatment at all, while others may pay a significant portion of your treatment costs. Most insurance plans pay 40-80%. Most plans also have a yearly maximum. It is interesting to note that dental insurance coverage is about the same today as it was in the 1960’s, yet dental insurance premiums have increased tremendously during the past 40 years.
Dental insurance is much different than medical insurance. Dental insurance operates more like a coupon. It allows partial payment of some, but not all, dental procedures. In addition, there is a large amount of fine print that can severely restrict the conditions that must be met for the insurance company to pay the claim.
If your carrier is up-to-date, your insurance claim will be transmitted electronically before the end of your treatment day. Once your carrier has paid the claim, any difference will be due upon receipt of our statement. If your insurance company postpones payment for more than 60 days, we ask that you make the remaining payment while we work together to get the insurance company to pay you their obligations. After the 60 day grace period, the remaining balance is subject to an interest charge of 18% APR.
Many plans base the amount of benefit on a schedule of fees arbitrarily developed by insurance companies. This is called a “UCR”. What does “UCR” mean? Great question! It is an insurance company term for Usual and Customary Rate. It is an artificial number that insurance companies created to minimize what they pay out. If you ask your insurance company for supporting documentation of their UCR fees, you most likely won't get an answer. For example, if your plan states that it will pay 70% of the cost of a specific treatment, it probably means 70% of the fee arbitrarily determined by the insurance company and not the actual fee charged by our office. The financial obligations for the dental treatment are between you and our office.
What is “LEAT”? It is an insurance company term for Least Expensive Alternate Treatment. It is another tool insurance companies use to avoid payment for certain procedures. It may be written in your contract. You may be a victim of LEAT. An example would be: Denial for a crown (cap) and instead being reimbursed for a filling, or denial for a tooth-colored filling and reimbursement for a silver metal filling. Those are far from being the same procedures. You can be pretty certain that an insurance company executive would not settle for LEAT!
For the above reasons, you may receive a lower percentage than the reimbursement level indicated in your dental plan.
