Why we are taking the guesswork out of Insurance and what does this mean for you?

We consider our relationship with you to be of primary importance. We will always make our recommendations to you based on what we believe is the very best treatment for you regardless of your insurance coverage.

While we do not limit your treatment to what your dental benefits may allow, we are respectful of concerns regarding the cost of dental care and work with you to control those costs.  Dental insurance is playing a more substantial and more significant role in helping people obtain dental treatment. Since we feel strongly that our patients deserve the best dental care we can provide and to maintain a high quality of care, we would like to share some facts about dental insurance with you. 

What to expect:

You’ll know exactly what your appointment is going to cost! We accept full payment at the time of scheduling, we will file insurance for you, and there won’t be anymore: we’re expecting insurance to pay or based off of your benefits or your estimated portion will be…

There is no wait time to know how much insurance will or will not be paying.

Clear pricing will allow you to budget and know exactly how much will be due when scheduling your services.

Pay once and you’re done! No follow-up texts, phone calls, or invoices in the mail. You pay one time, the day you schedule, and wait for your reimbursement check!

We’ll still file the claim for you! 

We are the biggest advocate when it comes to filing and refiling claims. We will call, submit claims, x-rays, and charting, so you will be maximizing your benefits AND you won’t have to spend your time dealing with the insurance company.

YOUR CHOICE!

We offer our Perio Membership plan, Care Credit, and Lending Club for our patients! You can choose which of these payment methods works best for you.

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, and some pay less. 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.

Fact 2 – OUR OFFICE does not determine BENEFITS 

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. Dealing with these dental benefits companies can be difficult and time-consuming — more on Insurance UCR by clicking this link.

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 specific service. This can be very misleading and is not accurate. Especially with COVID, and the 1000% percent jump in gloves and masks for the dental and medical communities. Insurances have raised premiums, not passed on those savings to the patient or doctors.

Insurance companies set their 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 over 10 years old, and the insurance company sets these “allowable” fees so they can make a net 25%-35% profit.

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 usual, customary, or reasonable (UCR) figure.

Fact 3 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming 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 $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will later pay 80% of $100.00, or $80.00. 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 benefits will also be significantly less. It is considered insurance fraud to write off ( or, in other words, to not collect) the patient’s portion when the insurer agrees to pay a percentage of treatment.

 

Call today for an appointment: 503-385-8821