Our office accepts most major insurance plans and will file for you as a courtesy. You will be responsible for the estimated amount insurance is not expected to pay. We cannot guarantee the amount that your insurance company will pay, but we will file for you. We will be glad to send a refund to you if your insurance pays us. Again, we file insurance for our patients as a courtesy, and do not control the amount your insurer covers.
PLEASE UNDERSTAND that we are not responsible for how your insurance company handles its claims, or for the benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We do not guarantee what your insurance will do with each claim. We are not responsible for any errors in filing your insurance.
Usual and Customary (UCR)
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.
Insurance companies set their own schedules, and each company uses a different set of fees they consider reasonable. These reasonable fees may vary, 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 fees are set by the insurance company so they can net a 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 reasonable (UCR) figure.
Deductibles and Co-Payments Must Be Considered
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume a service fee 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 averages $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.
