Understanding Dental Insurance
We accept a number of dental insurances including DELTA DENTAL, METLIFE, UNITED CONCORDIA, AETNA, and CIGNA just to name a few . We will be happy to go over benefits with you to determine approximately how much your insurance company will pay on a given procedure, but the ultimate responsibility lies with you. We offer this service as a courtesy to our patients, please accept it in the spirit in which it is offered and keep in mind that the majority of dental offices demand payment in full and leave the paperwork up to you.
We strongly suggest that you be aware of what benefits you have available and the services you are eligible for prior to your appointment. If you so choose, we will be happy to submit a pre-estimate to your insurance company prior to treatment. We do our very best to determine eligibility prior to your visit but the ultimate responsibility lies with the patient.
If you are concerned about insurance coverage on services being performed at your next visit, you should contact your insurance company to inquire about what is or is not covered. We are faced with many different insurance plans and cannot be responsible for knowing each patient's individual dental insurance plan inside and out. Our primary concern is providing the best possible care to you, our patient, and not allowing your insurance company dictate what our standard of care should be.
Dental benefits are a wonderful way to supplement a patient's dental health. As a courtesy we will submit your claim to your insurance company. Please be aware that most dental plans do not cover 100% of the cost of your treatment. Because of this, and the extreme delay in receiving payment from the insurance company, you will be asked to pay your deductible and the estimated portion of your charges the day service is rendered. Please remember, this is only an estimate--not a guarantee of payment by the insurance company, and is based on the information available to us from your insurance company.
Do not let policy limitations determine your dental care! Treatment should be based on an informed decision by you, and not an insurance representative. Professional care is provided to you, the patient, not the insurance company.
Your dental 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. T his 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 3-5 years old and these "allowable" fees are set by the insurance company so they can make a net 20%-30% profit. Insurance policies vary in the amount that will be paid toward any charges.
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 UCR figure. Insurance policies vary in the amount that will be paid toward any charges. 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. The proper relationship between the patient, dentist, and insurance carrier is often misunderstood. We render to you our very best care and charge you a fee for that service. Just as the insurance companies do not allow us to set their premium rates, we do not allow them to set our fees or determine our procedures. These fees are between you and our office, and the insurance company does not enter into this relationship. Therefore, you have the final responsibility for payment of all fees rendered on your behalf. If there is a difference between what our office estimated and what an insurance company actually pays for a procedure, you are responsible for that amount, which will be billed immediately. If your insurance company pays less than estimated, you should take the matter up with the insurance company--not our office. In addition, if your insurance has not paid in 90 days, you are responsible for the balance in full regardless of the corresponding claim.
One last reminder, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment. Failure to notify us at the time of your appointment may cause a delay in filing your insurance claim and, after 90 days, you are responsible for the balance in full regardless of the corresponding claim.
If you have questions or concerns about insurance, please do not hesitate to talk to our Senior Insurance Specialist/Patient Accounts Manager, Liz at (925) 322-9922.