office policy regarding dental insurance/BENEFIT Plans

We consider our relationship with you to be of primary importance and 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. 

  • Many insurance companies will not give out accurate estimates, and they will not offer any guarantees of payment on their reimbursement to any dental office fees until after the treatment is completed. Dealing with these dental benefits companies can be difficult and time-consuming — more on Insurance UCR by clicking this link.

  • We work with over 100+ insurances and will do our best to get the most benefit out of your plan by billing your insurance for you.  

  • We accept assignment of benefits from all insurance plans as courtesy except for OHP, Medicaid/Medicare, Kaiser Permanente, Shasta, and Willamette (or other HMO’s). We can accept you as a patient; however, you will not be able to receive reimbursement for these services if you come to our office.  We accept these patients as cash patients.

  • We are preferred providers for Delta Dental Premier Plan of Oregon.  

  • As a courtesy, we will file your dental insurance claim for your reimbursement.  Your dental insurance has a contract with you through your employer. We are a third-party billing on your behalf.  Your assistance may be required in billing on your behalf.

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.

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.

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 three to five years old, and the insurance company sets these “allowable” fees so they can make a net 20%-30% 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.

Your first visit to our office

It is a policy to collect upfront for your first visit regardless of insurance coverage, meaning you will pay the full fee for your first exam, and your insurance will be billed as a courtesy.  Any credit from dental insurance billed on your behalf may go toward the procedures we have recommended for you. Should you choose not to have care at our office, a refund will be processed toward the payment option you chose.

Your second Visit to Our office: We offer Dental Pre-determinations FOR THOSE WITH DENTAL INSURANCE

We offer a complimentary benefits check once you become a patient.   Pre-determinations can be sent out after you become a patient, but are not a guarantee of coverage or payment from your insurance carrier.  Our promise to you is that we will always tell you our fees and if treatment changes what that work may entail. 

Our team will do their best to help you utilize your insurance benefit, but we can not offer a guarantee as what they will pay.  That agreement is impossible to predict and changes based on employer/insurance agreements that do not include your providers.   An important note is that any dental work done at other offices can affect payment for procedures done at our office.  Due to the delay created by dental benefit/insurance companies in paying your benefits, sometimes as long as 30-60 days, benefits left during the year may not be accurately reported by your insurance carrier.  This is why pre-determinations are never a guarantee of payment.

All future collections for surgery or other treatment needed in the future require your copayment (the amount we estimate not to be paid by your insurance) to schedule your procedure (or at least five days before your upcoming surgery), and any amounts over-paid by your insurance will be refunded to you. Conversely, should your insurance not pay as agreed you will be responsible for the remaining balance.

What to expect:

  •  Please bring your insurance card or insurance information to your initial visit if you would like us to bill your dental benefits plan on your behalf. MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

  • We provide you with a treatment plan, including your estimated “out of pocket” expense for your dental treatment. We will estimate your portion and ask you to pay that amount at the time of scheduling your surgery at a pre-operative visit. If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount of insurance is not expected to pay to schedule your surgical visit.

  • By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 25 days, whether insurance has paid or not. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if your insurance pays us.

    Please understand that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.

Call today for an appointment: 503-385-8821