Dental Insurance Policy
As a courtesy to you, our patient, we will file your Primary dental insurance claim for you if we have received all of your insurance information on the day of the appointment. We will also accept assignment of benefits. We will file your insurance claim for you and you will be expected to pay your estimated uncovered portion at the time of service. You must be familiar with your insurance benefits, as we will collect from you on the day of treatment the estimated amount insurance is not expected to pay. Once the insurance company reimburses our office, if there is still a balance, you will be billed for the remaining portion. If there is a credit, you will be sent a refund check. Please be aware our office does not file secondary insurance.
We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for the entire account balance. If for some reason your insurance company does not pay on your claim, you will be expected to pay it in full within 30 days of the date of treatment. Please note that some insurance carriers will not reimburse our office directly. In such instances, you are will be responsible for the full cost of each visit at the time services are provided and your insurance company will send you the reimbursement check directly.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. There is no direct relationship with your insurance company and our office. 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 and we will verify your benefits prior to treatment whenever possible. If you have any questions we will be happy to assist you. Please do not hesitate to call.
We participate In-Network in the following insurances:
Pediatric Dentistry: BCBS of NC and Grid+ Network, Cigna Standard and most Delta Dental Plans.
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, 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 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
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 certain service. This can be very misleading and simply is not accurate.
Insurance companies set their own 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 are from various parts of the country. These “allowable” fees are set by the insurance company 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. 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.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.