FOR PATIENTS
 
 
 
 
 

Financial and Insurance Information

 

What You Should Know About Managed Care and Insurance
Our office establishes policies for payments of fees and acceptance of insurance
reimbursement, but the more you know and understand about your insurance plan the better our relationship will be.

Initial Consultation and Maintenance Visits
In order to keep our fees as low as possible we do not accept insurance assignment for initial consultation or maintenance (cleaning) visits. (We would have to raise our fees substantially to cover the administrative cost of doing this). We ask you to pay us for these appointments and we will be happy to file your insurance claim and have the insurance company reimburse you directly. We will accept insurance assignment on most other appointments.

Usual, Customary, Or Reasonable (UCR)
Another way that the insurance companies limit their coverage is a term called UCR. Typically, the insurance company and your employer determine the reimbursement level that varies from 50 to 90% of what dentists in the area charge. For a particular procedure that most dentists charge $550.00, some policies may base their claims payment at $600.00 or higher. If the employer wants to keep costs down, one option is to buy a plan that reimburses at a reduced level. In other words, instead of reimbursing at $550.00 or higher, it may only reimburse at $500.00 or less on the same procedure.

The $500.00 reimbursement reduces the cost of the insurance policy. If our charge is $550.00 (the amount that most dentists charges), the carrier is likely to state that our fee was above the "Usual, Customary, and Reasonable" fee. This comment would naturally make you think that our fee is higher than most, which is not the case. Although this can be a common misconception, it would be more accurate to state that your employer chose a plan that does not reimburse at the level most dentists charge in the area. The patient is responsible for more "out of pocket" expense because their coverage was reduced to lower the premiums of the policy.

It is also important to realize other employers with the same insurance company (or even those with a different carrier) would consider the $550.00 a "reasonable" fee. Our office strives to produce excellence on a daily basis. In many instances there is nothing "usual or customary" about how you are treated while under our care.

Fees
We strive to keep our fees as low as possible for the benefit of everyone. We do not establish our fees on the basis that insurance companies will pay them. As a benefit to you, we will accept insurance assignment on procedures other than initial consultation and maintenance visits. Any balance remaining on your account after insurance payment has been received is your responsibility. We hope you have found this information useful. Insurance matters are often complicated, so if you have any questions regarding your coverage, please feel free to talk to Dr. Frantz, Dr. Langanor our financial coordinator.