We are 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 pay 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 at no time guarantee what your insurance will or will not do with each claim . We are not responsible for any errors in filling 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 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 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 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 sent by the insurance company, so they can make a net 20%-30% profit.
Unfortunately , insurance companies imply that your dentist is “over charging” 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’t 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. The insurance company will then pay 80% of $100.00 , or $80.00. Out of a paid $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 plans pays only 50% then the insurance benefits will also be significantly less.
Most importantly , please keep us informed of any changes such as policy name, insurance changes, company address or a change of enrollment.
We work with most PPO insurance companies. We are in network with Cigna, Eagles and Delta insurance Companies.