Dental Insurance 101

Fact- No Insurance Pays 100% of All Procedures

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 is usually determined by how much you or your employer has paid for the coverage, or the type of contract your employer has set up with the insurance company.

Fact – Benefits Are Not Determined by Our Office

You may have noticed that sometimes your dental insurance 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 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 not accurate. 

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

Consideration: In most cases you can look up your benefits online or feel free to call our office and we can help you.  We can only assist in estimating your portion of the cost of treatment.  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 a part of the contract you have with your dental benefits company. We are not responsible for how your insurance company handles it’s claims or for what benefits they pay on a claim, however, we’ll always do our best to get you the benefits you deserve!

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