1. Filing Claims
- Provide Insurance Details: To have your claim filed on your behalf, please provide all relevant insurance information by the day of your appointment.
- Know Your Benefits: It is your responsibility to be familiar with your insurance coverage and plan details.
- Payments Not Covered: You are responsible for paying any amount not expected to be covered by your insurance.
2. Insurance Payment Timeline
- 30-Day Requirement: Insurance companies are generally required to pay within 30 days of receiving a claim.
- Electronic Filing: Our office submits claims electronically, ensuring your insurer receives them as quickly as possible.
- Remaining Balances: If your insurance has not paid within 30 days, any remaining balance becomes your responsibility.
3. Insurance Handling
- Courtesy Filing: We file insurance claims as a courtesy to you. However, we are not responsible for how your insurance company processes or pays these claims.
- No Guarantees: We cannot guarantee that your insurance will cover all or part of any treatment.
4. Understanding Dental Insurance
- No Insurance Pays 100%: Most dental policies cover only 40–80% of the total fee, and not all procedures are covered at higher percentages.
- Reimbursement Discrepancies: Insurance companies sometimes pay less than the dentist’s fee, citing “Usual, Customary, or Reasonable (UCR)” charges. This does not necessarily mean the dentist’s fees are too high, but rather that the insurer may use outdated data to determine UCR fees.
- Older Data for UCR: Insurance companies often rely on data that can be three to seven years old, setting reimbursement rates in a way that ensures their profitability.
5. Deductibles & Co-Payments
- Consider These Costs: When estimating what your insurance will pay, always factor in your deductible and co-payment.
- Example:
- Procedure Fee: $250
- Insurance “Allowed” Amount: $250
- Deductible: $50
- Remaining Amount: $200
- Coverage Rate: 80% of $200 = $160 paid by insurer
- Your Responsibility: $50 (deductible) + $40 (remaining 20%) = $90 total
6. Notify Us of Insurance Changes
- Keep Information Updated: If there are any changes to your insurance—such as a new policy name, a change in the insurance company’s address, or changes in employment—please inform our office immediately.
Conclusion
Our office will gladly assist you by filing insurance claims as a courtesy. However, it is important to:
- Understand your benefits.
- Pay any balance not covered by insurance.
- Inform us of any changes to your insurance information.