Insurance Policy

We are a private care office. We will be happy to file your claim as a courtesy. By law, your insurance company is required to pay each claim within 30 days of receipt. We will file your insurance claim electronically, so your claim will be received within days of treatment. We will be glad to send you a refund if your insurance pays us.

We do not have a contract with your insurance company; only you do. We cannot be responsible for how your insurance company handles its claim or for what benefits they pay on a claim. We can try to assist you in estimating your benefits and how much your insurance will reimburse you if you provide us with accurate insurance information. We will at no time guarantee what your insurance will or will not do with each claim. We are not responsible for any errors in filling out your insurance claim. We file claims as a courtesy to you.

Fact 1: No insurance pays 100% of all procedures.

Dental insurance is meant to 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% and 80% of the average total fee. Some pay more, some pay less. The amount you or your employer have paid for coverage or the type of agreement your employer has set up with the insurance company typically determines the percentage paid.

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 the reimbursement was reduced because your dentist’s fee exceeded the usual, customary, or reasonable fee (UCR") used by the company.

A statement like this gives the impression that any fee higher than what the insurance company pays is excessive or significantly higher than what the majority of dentists in the area charge for a particular service. This can be very misleading and is simply 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 fees and information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCF fee. Frequently, this data can be three to five years old, and 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 saying 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 and 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’t figure out what benefits will be paid. The first step is to deduct an average $50 deductible that you are responsible for paying, leaving $100. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150 fee, they will pay an estimated $80.00, leaving the patient to pay the remaining $70.00. Of course, if the UCR is less than $150.00 or your plan pays only 50%, then the insurance benefits will also be significantly less.

Most importantly, please keep us informed of any changes, such as policy names, insurance changes, company addresses, or changes in enrollment.

We work with most PPO insurance companies.