We accept most dental insurances. You can contact our office to verify acceptance of your plan. If we are not “in network” with your insurance then we would be considered an “out of network” provider.
We will be happy to go over benefits with you and give you an estimate of how much your insurance company will pay. As a courtesy, we will submit your insurance claims for you. The balance of the fee is expected to be paid by you at the time of treatment. This is only an estimate, not a guarantee of payment by the insurance company, and is based on the information provided by your insurance company. The ultimate responsibility lies with you, the patient. Once the insurance company processes the claim then and only then will we know the exact amount of benefits paid by insurance and how much is due by you. You will then receive a statement. We do however encourage you to be familiar with your benefits prior to your appointment. Usually the best person to provide you with this information is your plan sponsor (often your employer).
WHAT YOU SHOULD KNOW ABOUT YOUR DENTAL INSURANCE.
Dental insurance is designed to supplement the cost of dental care.
Dental insurance differ from most other insurances. Most plans do not cover 100% of the cost of your treatment but are designed to provide you with assistance in paying for your dental care.
Your plan may have limitations on the various treatments it will cover.
We do not let insurance benefits dictate our treatment. We make recommendations based on what is the best possible care for you and not what the insurance will or will not cover. You should base treatment on an informed decision, not by your insurance limitations. We provide professional care to you, not the insurance company.
Usual, Customary and Reasonable
“Usual, customary and reasonable” or “UCR” is what the insurance company base their reimbursement limits from. Although these limits are called “customary”, they may not reflect the actual fees that dentists in your area charge. Your insurance company may state that the fee your dentist charged is higher than the UCR limits. This does not mean that you have been overcharged. There are no regulations as to how insurance companies determine reimbursement levels. Insurance companies set their own limits and each company uses a different set of fees they consider reasonable.
Least Expensive Alternative Treatment
Your dental plan may not allow benefits for all treatment options, even when your dentist determines that a specific treatment is in your best interest. As with other choices in life, such as purchasing medical or car insurance, the least expensive alternative is not always the best option.
Annual Maximum
Your dental plan purchaser (your employer) makes the final decision on the “maximum levels” of reimbursement. It is usually based on the amount the employer wishes to pay for the dental benefits. Even though the cost of dental care has increased significantly over the years, the maximum levels of reimbursement have not changed much in 30 years.
Pre-existing Conditions
Just like medical insurance, a dental plan may not cover conditions a person had before enrolling in the plan. Even though your plan may not cover certain conditions, treatment may be necessary. Your dental plan may not cover certain procedures or preventative treatment. This does not mean these treatments are unnecessary.