Financial Arrangement and Insurance

      It is our policy to discuss fees and financial arrangements openly and honestly with you. As a courtesy to our patients, we will contact your insurance company for your plan benefit by asking for your insurance information prior to the appointment. Based on the information, we will estimate the amount not expected to be paid by the insurance and collect this fee when you check into our office, unless a financial arrangement has been previously made with our office. 

    PLEASE NOTE that patients are responsible for the full financial cost of the dental treatment regardless of their insurance situation. Based on the information provided by you and your insurance company, we will make every effort in estimating the total cost of each dental treatment.

    Please understand that we file dental insurance as a courtesy to our patients. Specific coverage and handling of benefit are determined by the insurance company. We can only assist in estimating your portion of the payment for the services we provide. Therefore, the exact amount of payment from the insurance company is never known to our office until the claim is sent after the dental procedure is completed. For this reason, you may receive a bill from our office for the remaining balance not covered by your insurance. Similarly, should the insurance company pay for more than the estimated amount, we will send you a refund check within 60 days.

    After an insurance claim is processed, we will wait up to 60 days for payment from your insurance company. If no payment is received,it is your responsibility to pay for the remaining balance and contact the insurance company directly for further inquiries. Ultimately, we are not responsible for any errors in filing your insurance, but will make every effort to help our patients through this process. Once again, we file claims as a courtesy to our patients.

   We accept most insurance providers. As a courtesy to our patients, we help file all claims on your behalf. However, the ultimate responsibility for the claim payment belongs to you. We will assist you in estimating your portion of the treatment cost, but cannot predict the actions of your insurance company. To increase accuracy of treatment cost estimation, PLEASE keep us informed of any changes to your name, insurance information, and employment. 

    FACTS ABOUT DENTAL INSURANCE 

    Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES 

   Dental insurance is meant to provide assistance in payment. Many patients assume that their insurance pays 90%-100% of all dental fees. This is not true! Most plans pay between 50-80% of the average total fee. Your coverage is usually determined by the type of contract selected by your employer and how much you or your employer has paid for coverage. 

     Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE (?)
   You may have sometimes noticed that your dental insurer reimburses you or your dentist at a rate lower than that of the dentist's actual fee. In these situations, insurance companies may explain that the reimbursement rate was reduced because the dentist's fee exceeds the usual, customary, or reasonable fee ("UCR") used by the company.

   Such statements imply that fees greater than the paid amount by the insurance company are unreasonable or exceed the average fee charged by other dentists in the area. This is very misleading and simply not accurate. 

   UCR fees vary widely from one insurance company to another. Each insurance company determines the amount of coverage for a given procedure and sets a UCR fee that allows for a 20-30% profit by the insurance company. 

   We are acutely aware of the Please 

   In general, the less expensive insurance policies will use a lower usual, customary, or reasonable (UCR) figure. Rather than admitting to a limited benefit package, some insurance companies will imply that dental offices “overcharge.” 

    Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED 
   When estimating dental benefits, deductibles and percent of coverage must be considered. For example, let’s calculate your benefit for a dental procedure that costs $150.00, assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee. First, we will subtract your deductible, which is $50 on average, from $150, which leaves $100. Then, for a plan that pays 80% for this particular procedure, the insurance company will pay 80% of $100.00, or $80.00. So, for a bill of $150.00, the insurance company will pay an estimated $80.00, leaving the remaining portion of $70.00 to be paid by the patient. This is the calculation we use in determining your estimated fee. Your benefits can be significantly more or less, depending on the allowable UCR and the percentage of coverage for each procedure.