If you have dental insurance, our office manager will work with you to maximize your insurance reimbursement for covered procedures. As a service to you, we will confirm your eligibility, discover the amount your insurance is estimated to pay, and file your insurance claim. Any amount that is not estimated to be covered by your insurance is to be paid by you in full at the time services are rendered. Since insurance companies do not guarantee the accuracy of the estimates they provide, we cannot guarantee their estimate and you should consider their estimate as only a guideline until the final insurance payment is received. You are responsible to pay any difference between the insurance payment and the fee for services rendered.
We will provide the services described above for a patient insured by any insurance company. Because we have contracted agreements with the companies below, additional savings may accrue to patients insured by the following insurance carriers and insurers who fall under the umbrella of these carriers:
- Delta Dental
- Advantage Dental
- Cigna Dental Network Savings Program
- Aetna
Understanding Dental Insurance Benefits
The benefits provided by your insurance plan were negotiated between your employer and your insurance carrier. Different employers select different plans and it is important that you read the information provided by your insurance carrier to understand what benefits they provide for endodontic treatment. Answers to some commonly asked questions about insurance benefits are provided below.
- What is “UCR” or the allowable maximum?: UCR and allowable maximum are terms used by insurance companies to describe the amount they are willing to pay for a particular procedure. There is no standard fee or an accepted method for determining UCRs or maximum allowable fees. The UCR has no relationship to the fee charged by dental offices and is set by individual insurance companies based on their calculations to profitably administer their dental benefit plans. Because of law suits against insurance companies, a website (www.fairhealthconsumer.org) was developed to help consumers learn the cost of medical and dental services typically charged in an area by zip code.
- What will insurance pay? The amount insurance plans pay varies according to many factors such as your annual maximum benefit, benefit used to date, your deductible, and services covered or excluded by the plan. Although insurance companies may provide estimates regarding payments (for example, many state they will pay 80% for root canal treatment), they usually will not release information regarding their UCR calculations and they may choose to disallow certain services based on the benefits negotiated for your plan. Therefore, the amount that will actually be paid by the insurance company will not be known until the insurance company releases its Explanation of Benefits.
- Why might the treatment not be a covered benefit? We diagnose and provide treatment based on your health needs rather than on the benefits covered by insurance plans or on the cost of treatment. Some employers and/or insurance plans exclude or disallow coverage for necessary treatment as a way to reduce their costs. Your plan may exclude certain procedures, although they were deemed necessary for the proper diagnosis and treatment of your condition.
- How long does it take for my insurance company to issue payment? Again this varies, but at least 38 states have passed laws that require dental insurance carriers to pay claims within a period ranging generally from 15 to 60 days. If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. The insurance commissioner wants to know if your insurance company does not pay within the period specified by state law. You may find the names and addresses of insurance commissioners by following this link: www.naic.org/state_web_map.htm.
