BASIC INSURANCE INFORMATION
Good communication is the foundation for building a great relationship. In order to provide our patients with exceptional customer service and build a bond of trust, we do our best to answer all questions with truth and accuracy. It has been our experience that insurance benefits are confusing to most people. Even those who work with it on a regular basis find it complex and difficult at times. We want your experience with our office to be easy and as stress free as possible. Therefore, it always helps if our office has prior knowledge of your (current) insurance coverage.
One way to avoid the “surprises” of insurance is to be aware of the specifics of your policy. Knowing the benefits, as well as the exclusions and limitations, is extremely beneficial. If you do not have a copy of your policy, contact the insurance company directly or the HR representative at your place of employment. Either of them should be happy to provide you with what you need. Of course, we realize sometimes the dental jargon is perplexing and you need a dictionary to decipher the meaning. Hopefully, between your insurance’s customer service department and our office, we can make sense of it all.
Another thing to remember is the fact that we can only give you an estimate of what your insurance will pay on a claim. We would love to give you exact numbers, but unfortunately the insurance company’s agreement is with you, and they will not share information to us that they deem to be private. As always, we truly appreciate your patience and understanding. Hopefully, by working together, we can make the best of a confusing situation and come out smiling on the other side.
Below is additional information you may find helpful. Please feel free to call us with any questions or concerns.
DO YOU TAKE MY INSURANCE?
We are currently in-network with Delta Dental, ODS, Met Life, BCBS, and United Concordia. However, we do accept and file all insurance as a courtesy to our patients. We have found that with most insurance companies you have the ability to choose your own dentist; however there are a few that do require you to see a network provider. We will be happy to contact your insurance company and verify your benefits before your appointment. We will initially ask you only for your estimated co-payment, but please understand that this is ONLY AN ESTIMATE based upon the information available to us. Therefore, the patient/primary policy holder is responsible for any unpaid balances.
WHAT DOES USUAL AND CUSTOMARY MEAN?
Almost all dental insurance companies use what is called a “usual, customary, and reasonable” (USR) fee guide. This means they set their own fee allowance for covered procedures. This is not based on what a dentist actually charges, but what the dental insurance company will only allow because that is the UCR fee they have set.
If your dental insurance policy requires you to go to a participating provider, you should not be charged the difference between these two prices. Remember, you will still be responsible for your co-payment. A contracted dentist generally has an agreement with the dental insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of pocket. However, you cannot put a price tag on quality dental care.
WHAT IS A “MISSING TOOTH” CLAUSE?
More than 90 percent of dental insurance policies carry a missing tooth clause. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or dental implant to replace the missing tooth, the insurance company would not have to pay for that service if they have a missing tooth clause in their dental plan.