Filing your insurance claim

If we have all insurance information on the day of appointment, we are happy to file your claim for you. It is the patient’s responsibility to be familiar with their insurance benefits, as we will collect the estimated amount insurance is not expected to pay. By law, insurance companies are required to pay each claim within 30 days of receipt. We file all insurance electronically so insurance companies should receive each claim within days of the treatment. Patients are responsible for any balance on their account after 30 days, whether insurance has paid or not. Over 60 day balances receive a $20 billing charge every 30 days and are sent to collections at 90 days. We will send a refund if an insurance claim comes through after a payment has been made.

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 of the cost due for the services we provide. We, at no time, guarantee what insurance will or will not do with each claim. Ultimately, we are not responsible for any errors in filing your insurance, but will make every effort to help our patients through this process. Once again, we file claims as a courtesy to our patients.

Facts about insurance:

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.

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 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 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 these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is “overcharging” 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.

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 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 $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 plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.