Dental Insurance 101

Fact- No Insurance Pays 100% of All Procedures

Dental insurance is intended to help cover the cost of dental care. Many patients believe their insurance covers 90%-100% of dental fees. This is not true! Most plans only pay between 50%-80% of the average total cost. Some pay more, and some pay less. The percentage is usually determined by how much you or your employer has paid for the coverage, or by the type of contract your employer has with the insurance company.

Fact – Our Office does not determine Benefits

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 the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (UCR) or allowable used by the company.

A statement like this suggests that any fee above the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for the same service. This can be misleading and inaccurate.

Insurance companies set their own fee schedules; each company uses a different set of allowable fees, and these fees may vary widely.

Consideration

In most cases, you can look up your benefits online or call our office, and we can help you. We can only assist with estimating your share of the treatment cost. Please remember you are fully responsible for all fees charged by our office, regardless of your insurance coverage.

Please understand that we file dental claims as a courtesy to our patients. We are not part of your contract with your dental benefits company. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim; however, we’ll always do our best to get you the benefits you deserve!