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Insurance Q & A
Many of our patients request our assistance in the filing of insurance claims. We are pleased to provide this service. We are in network with Delta Dental Premier, however we accept all PPO insurance plans. We will accept the insurance estimation as a partial payment. For the remaining portion we gladly accept cash, personal checks, credit cards or CareCredit (same as cash, interest-free credit line) for your dental investment. Please keep in mind we can only provide estimates of what insurance will pay. Any portion they do not pay is your responsibility. We believe that financial consideration should not be an obstacle in obtaining this life-enhancing, important dental care, an excellent investment in your medical and psychological well-being. We are always available to answer your questions or assist you in any way we can. Thank you for your understanding and compliance with these payment guidelines.
Why doesn’t my insurance pay for this?
Frequently our patients ask us what their insurance will cover and, “Why doesn’t my insurance pay for this?” The following explanation has been provided by the American Dental Association in 2009. We hope that it answers your questions.
* UCR (Usual, Customary and Reasonable)
Under a UCR plan, patients are usually allowed to see the dentist of their choice. These plans pay an established percentage of the dentist’s fee or pay the plan sponsor’s “customary” or “reasonable” fee limit, whichever is less. Although these limits are called “customary”, they may or may not reflect the fees that area dentists charge.
It may also be noted on your bill the fee that your dentist has charged you is higher than the reimbursement levels of UCR. This does not mean your dentist is overcharging you. For example, the insurance company may not have taken into account up-to-date, regional data in determining a reimbursement level.
Why? There is no regulation as to how insurance companies determine reimbursement levels, resulting in wide fluctuation. In addition, insurance companies are not required to disclose how they determine these levels. The language used in this process may be inconsistent among carriers and difficult to understand.
* Annual maximums
Your plan purchaser makes the final decision on “maximum levels” of reimbursement through the contract with the insurance company. Even though the cost of dental care has significantly increased over the years, the maximum-levels of insurance reimbursements have remained the same since the late 1960s. Many plans offer higher maximums that are comparable to rising dental care costs.
* Preferred providers
Your plan may want you to choose your dental care from a list of their preferred providers. Whether or not you choose your dental care from this defined group can affect your levels of reimbursement.
* Least expensive alternative treatment
Your dental plan may only allow benefits for the least expensive treatment for a condition. For example, your dentist may recommend a crown, but your insurance may only offer reimbursement for a large filling. As with other choices in life – such as purchasing medical or automobile insurance, or buying a home – the least expensive alternative is not always the best option.
* Preexisting conditions
Just like your medical insurance, your dental plan may not cover conditions that existed before you enrolled in the plan. Even though your plan may not cover certain conditions, treatment may still be necessary.
* Treatment Exclusions
Your dental plan may not cover certain procedures, or preventative treatments such as sealants that can save you money later. This does not mean these treatments are unnecessary. Dr. Han can help you decide what type of treatment is best for you.