Important Facts Regarding Dental Insurance | The Dental Arts Center Website

Important Facts Regarding Dental Insurance

We strongly feel that our patients deserve the best possible dental care we can provide. In an effort to maintain this high quality of care, we would like to share with you some facts about DENTAL INSURANCE.

PLEASE UNDERSTAND THAT NO PLAN IS A PAY-ALL

Dental insurance is meant to be an aid to help functionally restore the mouth to sound dental health. It must be considered only as a subsidy for reconstructive dentistry.

It has been the experience of many dentists, however, that patients have gotten the impression that their plan will pay up to 90%, even 100% of the dental fees. This is simply not true. Most plans cover from 30-40% of the average total fee. Some pay more, some less. The percentage you receive is determined by how much your employer has paid for coverage. The less paid for insurance, the less you will receive in benefits. This is a basic economic fact.

THE BENEFITS ARE NOT DETERMINED BY OUR OFFICE

Insurance benefits are determined by the type of plan chosen by your employer. We are not involved with the insurance carrier in any way. Since dental services are rendered directly to the patient, it is ultimately the patient who is responsible for the charges. The insurance company is responsible to the patient. To avoid disappointment, we strongly suggest that you contact your insurance company to make sure that your assumptions are correct.

THE “USUAL AND CUSTOMARY” MYTH

Each insurance company will determine payment according to a fee schedule that has been determined by their standards.

To reiterate, your particular program may base its dollar allowance on a fee schedule which may not coincide with current acceptable fees.

INDIVIDUAL INSURANCE PLANS

Insurance has different plans available to your employer. They are typically called HMO, PPO, standard. We will file insurance for all PPO’s and standard plans. We may be considered out-of-network for some PPO plans, but you will find that your benefits are still applicable at our office.

A DEDUCTIBLE AND A CO-INSURANCE FACTOR MUST BE CONSIDERED

To illustrate, consider this example: A doctor places 4 units of dentistry at $100 per unit, amounting to $400 in value. Assume that the “usual and customary” allowance is $80 per unit. The insurance would “allow” $320 for $400 worth of treatment.

The deductible will then be subtracted- say $50. The payable amount is then $270. The co-insurance factor will then be calculated.-say 80/20. The insurance will pay 80% of $270 which equals $216. The patient balance of the original $400 is $184.

EVERY TREATMENT PLAN IS PROCESSED DIFFERENTLY

Each insurance company processes every claim and pre-treatment estimate on an individual basis. One crown on a patient may be covered and another one may not. Never assume that a treatment was once covered so it will always be covered.

SOME ROUTINE DENTAL SERVICES ARE NOT COVERED

Please read your policy so you are fully aware of any limitations on the benefits provided. We cannot be responsible for deficiencies or misunderstandings with individual plans. These matters are strictly between your employer and the insurance company.

A MAXIMUM COVERAGE PER YEAR MUST BE CONSIDERED

A maximum refers to the total liability of an insurance company. This maximum is usually based on a yearly basis. The year may be January to December. Some companies use fiscal years such as August to July. Please check this with your individual plan.

WE WILL DO ALL WE CAN TO DERIVE MAXIMUM BENEFITS FOR YOU

We are happy to complete forms and send them to your insurance company. We utilize electronic filing to be reimbursed as quickly as possible. As a courtesy to you we will file a claim one time to your insurance company. The patient, however, is responsible for the total fee and will be expected to pay the account balance within thirty days of insurance payment. Any balance that is due after ninety days will be immediately due by the patient and then reimbursement will be made to the patient if a payment is received by the insurance company.

SUMMARY

The Dental Arts Center PC has a standard fee schedule that is based on research for our geographical area.

Your policy may base its allowance on a schedule which may or may not coincide with current acceptable fees in our geographical area.

Insurance companies vary greatly in the types of coverage available.

All patients are financially responsible for their accounts. The insurance company is responsible to the patient. We strongly suggest that you become familiar with the provisions of your dental insurance coverage. We will cooperate in any way that we can to help you obtain maximum benefits.

Treatment plans are determined by your doctor’s diagnosis of treatment needed, NOT by insurance coverage.

Your dental office is considered a third party. Benefits and payments are determined by your employer and your insurance company.

You will be asked to pay an ESTIMATED patient portion at the time of service. Your total account responsibility can only be determined after all insurance payments or denials have been received.

Patient Info Menu

New patients can enjoy free teeth whitening with initial exam, cleaning and full mouth set of x-rays. Call us to schedule an appointment! (719)528-6441

We offer Invisalign®, the nearly invisible way to straighten your teeth! Click here for more information.

Invisalign® Straightening

New Patient Special