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.
After we have an assessment on your needs we will be happy to go over benefits with you and give you an estimate of how much your insurance company may pay for certain procedures.
As a courtesy, we will submit your insurance claims for you. An estimate of your initial responsibility of the fee will be collected AT THE TIME OF TREATMENT. The portion of the fee collected is only an estimate. It is not a guarantee that your insurance company will pay the difference. The estimates are based on the information provided by your insurance company. Should the insurance company not pay as estimated; the ultimate responsibility of full payment will be with you, the patient.
Once the insurance company processes the claim, then and only then, will we know the exact amount of benefits received and the remainder due by you. At this time, if there is balance due on the account, you will receive a statement.
We encourage all our patients to be familiar with their benefits prior to their appointments. Usually the best person to provide you with information regarding your benefits is your plan sponsor (often your employer). We will be more than happy to assist in that understanding.
UNDERSTANDING DENTAL INSURANCE
Dental insurance is designed to supplement the cost of dental care. 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. Our recommendations for necessary/needed treatments are not based on insurance coverage. WE MAKE RECOMMENDATIONS BASED ON WHAT IS THE BEST POSSIBLE CARE FOR YOU, NOT WHAT THE INSURANCE WILL OR WILL NOT COVER. You should base your decision regarding treatment on your “needs”, not on insurance coverage or limitations.
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.
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.
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.