Dental Insurance – Filing Your Insurance Claim
We will file your claim for you if we have all dental insurance information on the day of your appointment. It is the patients responsibility to be familiar with their insurance benefits. We will collect the estimated amount that insurance is not expected to pay.
By law insurance companies are required to pay each claim within thirty days of receipt. We file all insurance electronically so insurance companies should receive each claim within days of treatment.
Patients are responsible for any balance on their account after thirty days even if insurance has paid or not. An over sixty day balance on an account will be charged a $20.00 every thirty days until the bill is addressed. Collections are sent at ninety days. We will send a refund if an insurance claim has came through after a payment has been made.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients.
We contact your insurance company and ask for a breakdown of benefits available to you on your plan to help you understand and maximize the plan. We do not have a contract with each insurance company. Therefore the information they give us is limited. We can only assist in estimating the portion of the cost due for the service we provide.
We cannot guarantee what insurance will or will not do with each claim. Ultimately we are not responsible for any error in filing your insurance, but will make every effort to help our patients through this process. Once again, we file claims as a courtesy to our patients.
Facts about 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.
The percentage paid is usually determined by how much you and your employer contributes for the coverage or the type of contract you/employer established with the insurance provider.
Fact 2: BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes you dental insurer reimburses you or the dentist at a lower rate than the actual fee. Insurance companies frequently state that the reimbursement was reduced because your dentist 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 is simply is not accurate.
Insurance companies set their own schedules. Each provider uses a different set of fees they consider allowable. These allowable fees may vary 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.
This date can be three to five years old. The “allowable” fees are set by the insurance company so they can net a 20-30% profit.
Unfortunately, insurance companies imply that your dentist is “over charging” rather than say that they are “underpaying”. 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. For example, the fee for service is $150.00. Assume 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 is $50, is subtracted, leaving $100. The plan then pays 80% of the $100 which is $80. Out of a $150 fee they will pay an estimated $80 leaving you the remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150. or your plan pays on 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 change of employment.
Payment Plans and Financial Options
As our commitment to provide the highest quality of dental care available to all of our patients at an affordable rate, we are pleased to offer you these options of payment:
- VISA, MasterCard and Discover
- Pre Payment (Payments are made to our office in advance for you treatment)