Financial Policy

About Your Dental Insurance:

Filing Your Insurance Claim:

• PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with each insurance company; only the patient does. We are not responsible for how your insurance companies handle claims or for what benefits they pay on a claim. We can only assist in estimating the portion they will cover. We, at no time, guarantee what insurance will or will not do with each claim. Once again, we file claims as a courtesy to our patients and will make every effort to help our patients through this process. Please keep us informed of any changes in your insurance coverage. Many dental insurance companies issue checks directly to the patient and refuse to issue payments to a doctor who is not contracted with them. In this case, we will collect the full treatment fee from the patient. We will still submit claims to your insurance company as a courtesy to you, and your insurance provider will then mail all payments to you as a reimbursement.

Things You Should Know:

• DENTAL INSURANCE DOES NOT PAY 100% OFF 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 30%-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.
• YOUR DENTAL INSURANCE HAS A YEARLY CAP ON WHAT IT WILL PAY. In addition, your dental insurance only pays up to a certain amount each year. It is typical for patients to have a yearly maximum of $1000-$2000. Some pay more, while others pay less. Once you have reached that limit, they will discontinue paying for claims for the remainder of the year.
• INSURANCE COMPANIES SET THEIR FEE SCHEDULES 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 particular service. This can be very misleading and simply is not accurate. Insurance companies set their fee 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, and the insurance company sets these “allowable” fees so they can make a net 20%-30% profit. Unfortunately, insurance companies imply that your dentist is “overcharging” rather than saying they are “underpaying” or their benefits are low. Generally, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure. Dental insurance providers use the same fee schedule for all dentists, although all dentists are not the same. Your dentist referred you to us for specialty care. We cannot accept the same fees as general dentists.