We will file claims as a courtesy to you if you have all your insurance information. Insurance companies are required to pay claims within 30 days of receipt of the claim. We file claims electronically so your insurance company will receive the claim within days of treatment. Please review your insurance benefits as we will ask you to pay the estimated amount that your insurance is not expected to pay. You are responsible for any balance on your account after 30 days. If your balance is not paid within 60 days, a monthly, re-billing fee of 1.5% will be added to the account.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.
There are a number of things about dental insurance that you should keep in mind:
The purpose of dental insurance is to help you and your family to receive dental care. No insurance pays 100% of all procedures. Most plans pay between 50% and 80% of the average total fee. The percentage your insurance will pay depends on the premium you pay or the contract your employer has with the insurance company.
Our office does not determine the benefits you will be paid. You may notice that your insurance company reimburses at a lower rate than the actual fee. Frequently, insurance companies claim that the dentist’s fee “exceeds the usual, customary or reasonable fee” (URC) used by the company. Insurance companies set their own URC fee schedules and they vary widely from one company to another. Unfortunately, this suggests that the dental office is “overcharging,” not that they are “underpaying” based on data that may be three to five years old.
When estimating dental benefits, deductible and co-pays must be considered. The following example illustrates how an estimate is calculated:
Fee for service – $150.00 (with the insurance UCR at $150.00)
Deductible paid by you – $50.00
Balance – $100.00
80% of balance paid by insurance – $80.00
Remainder paid by you – $20.00
Under these circumstances you would pay $70.00 out of the total $150.00 fee. If the UCR is less than the fee or your plan pay less the 80% of the balance after your deductible, your portion of the bill will be greater.
It is very important that you keep us informed of any changes in your insurance including the policy name, company address or a change in your employment.
