Insurance Information
While most offices will "take" a patient's insurance, it's the office that is in "network" or a "preferred provider" with the insurance company that is most beneficial to the patient. Being a "preferred provider" means that we've agreed to accept a lower fee for our services. We've agreed to a lower fee to help the patient get as much value for her or his dollar as possible. By accepting the lower fee (sometimes as much as 30%) the patient pays less "out of pocket" to receive their treatment. We justify this write off as an advertising expense because we are on the insurance company's list of preferred providers.
We provide the following information in an effort to help our patients understand dental insurance and how it works. We will update this information as necessary.
Usually the insurance company only pays a percentage of the fee. This percentage may vary from plan to plan. Dental insurance is not designed to pay the entire cost of your treatment, but it is intended to help cover a certain portion of the cost. Please remember, however, the financial obligation for dental treatment is ultimately the patient’s responsibility.
We are happy to file the claim with the insurance company. However, any estimated co-pays and deductibles are due at the time the service is received.
Insurance coverage and benefits are based on the “cost” of the coverage. The higher the premiums are, the better the coverage and the greater the benefits. An insurance company may deem a fee above the usual and customary fee if the coverage is a low cost option and the benefits are substandard. We know this because the usual and customary fees vary from plan to plan and from company to company. Also, the insurance company may not have taken into account up-to-date, regional data in determining a reimbursement level.
We are glad to assist you in obtaining maximum benefits from your dental insurance plan. With over thirty years of experience, computers, newsletters, and continuing education courses we make every effort to accurately estimate benefits for each patient. Still, it has become increasingly difficult to provide “exact” coverage information. Many times there are “plan limitations and exclusions” that we are not aware of. Also, benefits paid to other offices are unknown to us. This may affect the benefits available for future treatment. We can quote our exact fees for each procedure but quoting benefits from the insurance company is provided as a “best effort” estimate.
We have found that many times secondary insurance will not provide benefits. In fact, many insurance companies will not commit to making any payments until the claim is filed. We ask for the co-payment not covered by the primary insurance to be paid at the appointment time. We will gladly file the secondary insurance. When a secondary payment is received any overpayment will be processed and sent to the patient the same business day.
Hopefully, this information has been helpful. As always feel free to contact our office with any questions or comments.
Monty C. Clark, D.D.S.
501-327-0587 info@DrMontyClark.com
