If we have received all of your insurance information on the appointment day, we will gladly submit your claim for you. On the day of your appointment, we will collect the portion of the cost that is covered by your insurance, as it is important for you to be aware of your insurance benefits. The insurance providers we work with are Guardian PPO and Cigna (DPPO network only). Please check with your insurance representative to confirm if we are “IN” network with the plan you have chosen. It is worth noting that different groups may have varying coverage depending on the insurance company. If you have any other dental insurance, you have the option to go IN or OUT of network. In the case of out of network insurance providers, we will collect the full payment at the time of your appointment and submit your claim as a courtesy. Your dental insurance will then reimburse you directly. It is important to know that your insurance company is legally obligated to pay each claim within 30 days of receiving it. We will electronically file all insurance claims, ensuring that your insurance company receives them promptly after the treatment is provided.
You will be held accountable for any outstanding amounts on your account after 30 days, regardless of whether or not insurance has made any payments. In case you fail to settle your balance within 60 days, a re-billing fee of 1.5% will be imposed on your account every month until the balance is cleared. If your insurance provider makes payments to us, we will happily issue a refund to you.
We understand that as a dental insurance provider, it is important for us to be courteous to our patients. Please note that we do not have a contract with your company’s insurance. We are not responsible for filing each claim or handling how your insurance company pays its benefits. Additionally, we cannot be held responsible for any errors that may occur during the filing of your insurance claims. Our role is to assist you in estimating the cost of your treatment only.
Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is intended to assist in receiving dental care. Many patients mistakenly believe that their dental insurance covers 100-90% of all dental fees. However, this is not accurate. Most dental plans only cover between 80-50% of the total average fee. Some individuals pay less, while others pay more. The percentage paid by the employer is typically determined by the type of contract set up with the insurance company or the amount of coverage paid by the employer.
Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that the reimbursement fee used by UCR (usual, customary, or reasonable fee) for dental services is sometimes lower than the actual fee charged by the dentist, which is frequently reimbursed by dental insurance companies.
This statement gives the impression that the fee paid by the insurance company for certain dental services in a specific area can be very misleading and not accurate, as it suggests that most dentists in that area charge a fee greater than what is reasonable or acceptable.
Insurance companies set these “allowable” fees so that they can make a net profit of 20-30%. These fees, known as Frequently Fee UCR, can vary widely because each company collects fee information from processing claims. Each company chooses a level of “allowable” fees arbitrarily and collects fee information from processing claims. These allowable fees may vary widely because each company uses its own set of different fees and schedules.
Unfortunately, insurance companies often imply that your dentist is “overcharging” rather than saying they are underpaying benefits, which can make insurance policies less expensive for the general public by lowering the reasonable or customary figure that UCR uses.
Fact 3 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, it is important to consider percentages and deductibles. Assuming that the insurance company allows $150.00 as its customary and usual fee (UCR), we can figure out what benefits will be paid by subtracting the average deductible of $50.00 from the fee of $150.00, leaving $100.00. The plan will then pay 80% of this particular procedure. The insurance company will pay 80% of $100.00, which is $80.00. Alternatively, the insurance company will pay 80% of $100.00, which is also $80.00. They will pay an estimated fee of $150.00 out of $80.00. The remaining portion to be paid by the patient is $70.00. If the UCR is less than $150.00, your insurance plan will also pay significantly less, at only 50% or less.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.