Dental Insurance Policy
Dentist Schaumburg, IL
We file dental insurance as a courtesy to our patients.
We do not have a contract with your insurance company; only you and your employer do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We can’t guarantee what your insurance will or will not do with each claim. We also can’t be responsible for any errors in filing your insurance. Claims filing is a courtesy service.
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 paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.
Insurance benefits are not determined by our office.
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 that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) 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 misleading and simply is not accurate.
Insurance companies set their own schedules, and each company determines the fees they consider allowable. These allowable fees may vary widely, 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 the “allowable” fees are set so the insurance company can make a net 20%-30% profit.
Unfortunately, the language used by your insurance company may make it seem that your dentist is “overcharging.” Often, the insurer is “underpaying” or their benefits are low. Note that, in general, a less expensive insurance policy will apply a lower usual, customary, or reasonable (UCR) figure.
Deductibles and co-payments must be considered.
When estimating dental benefits, deductibles and percentages are part of the cost and should be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can determine what benefits will be paid. First a deductible (paid by you), on average $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.
Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment as these changes can definitely affect your costs.