If we received all of your insurance information prior to the appointment, we will be happy to file your claim for you. While we have professionals in the office dedicated to dental insurance reimbursements for our patients, it is the responsibility of each patient to understand the significant differences between dental and medical insurance and his/her own policy. We will collect the entire investment and file the necessary claim to the dental insurance company as a courtesy service to the policy holder.  By law, your insurance company is required to pay each claim within 30 days of receipt. We file most insurances electronically, so your insurance company will receive each claim within days of your treatment. We will promptly send a refund to you if your insurance pays us.

Fact 1

Insurance companies are not interested in your health, they are interested solely in making money. The more they pay, the less money they make so they do everything to avoid or delay paying their portions. Often times they state they did not receive certain information because that will extend the requirement of them to pay their portion by 45 days. For this reason, we digitally document what is sent and when to the insurance company for the policy holders.

Fact 2

Dental insurance is meant to be an AID in receiving dental care. Many patient’s think that their insurance pays 90-100% of all dental fees, this is not true. Most plans only pay between 30-80% of the average fees. Some pay more, some pay less depending on the policy you signed up for. The percentage paid is directly related to how much you or your employer has paid for coverage, or the type of contract your employer has set up with your insurance company.

Fact 3

Sometimes your dental insurance reimburses the policy holder at a lower rate then the dentists actual fees. Frequently, insurance companies state 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 that amount paid by the insurance company is unreasonable, or well above what most dentist in the area charge for services. This can be very misleading and is not accurate in any sense of the word. It is important for the policy member to know that the UCR is completely determined by what the insurance company wants to pay for the procedure, and has nothing to do with regional fees.

Insurance companies set their own schedules, and each company uses a different set of fees they consider reasonable. These reasonable fees may vary, because each company collects fee information from claims it processes. Frequently, this data can be three to five years old and these fees are set by the insurance company so they can net a 20-30% profit.

Unfortunately, insurance companies will imply that your dentist is overcharging, rather to say that they are underpaying, or their benefits are low. In general, the less expensive insurance policy will use a lower reasonable figure.

Please keep us informed of any insurance changes such as policy name, insurance company, or a change of employment.