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TYLER GLASER DENTAL

Doctor Owned · Independent · Small Practice

Dental Insurance2023-04-20T14:04:36+00:00

Dental Insurance

Dental Insurance Coverage Explained

Glaser Dental accepts all plans with out-of-network benefits

And to make it easy, we’ll submit the paperwork to your insurance. 

What should I expect to pay?

Below is a link to help you estimate your dental care costs. It will show an estimate for out-of-network/uninsured and an average allowed amount by a health plan. The information is supplied by a third-party health care organization, FairHealth Consumer (not your insurance company and not us). It uses your Zip Code to determine the fair cash price.

Get Cost of Procedures

Dr. Glaser has always been and will continue to be open about his charges. We compare our fees to other comparable practices in our area. We also consider factors such as the materials we use in your body, the technology we use, the continuous training we are passionate about, and the level of service we provide when we set our fees. We maintain competitive fees because keeping great care accessible to everyone is important to Dr. Glaser.

Dental insurance FAQs

Below are answers to common, and some commonly misunderstood, questions about dental insurance coverage and reimbursement.

The member would pay the out-of-network provider upfront. the reimbursement check will be sent to the member’s home address and usually arrives 14 days later. It should be an easy process.

The annual max, deductible, and coinsurance level are usually the same (check your specific policy). However, there is still a chance for the balance billing… meaning the member could pay more out of pocket if the UCR set by your plan is not the same as the price set by your dentist.   The reimbursement levels are contingent on the allowable amount on each procedure (set by insurance companies)

We do our best to estimate what portion may be covered by your insurance company, but due to the limited information they provide, actual amounts cannot be determined. Maximum allowable charges, waiting periods, and frequency limitations can affect benefits.

General terms can be found in your insurance policy manual, website portal, or work human resources department. Be sure to ask how frequently services can be rendered (i.e., cleanings, Xrays, crowns) and if there are any waiting periods, annual maximums, and plan exclusions.

No. Predetermination is not required for treatment to begin. It will, however, help determine if a procedure is covered and how much will be paid by the insurance company. It can often take 4 to 6 weeks to receive the pre-determination from your insurance company, and it will still state that payment is not guaranteed.

Our Dental Wellness Plans allow for monthly payments for preventative care. It’s our in-house, uncomplicated alternative to traditional dental insurance.

We use a third-party service (Care Credit) for most other payment arrangements. You can apply for Care Credit here.

If you have specific concerns and are contemplating having Dr. Glaser do a smile revitalization – we are happy to discuss your specific financial concerns.

When you see a doctor or other healthcare provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or be required to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network. “Out-of-network” means providers and facilities without a contract with your health plan to provide services.

Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

Dr. Glaser will never SURPRISE YOU. His fees are transparent and in line with most area dental practices! We always discuss your investment before care. 

The No Surprises Act went into effect on Jan. 1, 2022, and gives consumers new billing protections when getting emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

According to the Centers for Medicare and Medicaid Services, the law’s protections against balance billing largely do not affect private dental offices because dental benefits are excepted benefits. The new requirements on balance billing generally apply to items and services provided to consumers enrolled in group health plans, group or individual health insurance coverage, and federal employees’ health benefits plans, but not excepted dental benefit plans.

Dr. Glaser treats his patients in a private fee-for-service practice. All fees for necessary procedures are discussed ahead of time, and patients always have our good faith estimate of costs. This is nothing new for us. We feel transparency in fees is essential to taking care of our patients. Unfortunately, when submitting to insurance, we do not know what FEE, referred to as UCR, reasonable and customary, or MAC, the insurance company will base your reimbursement on. We feel our fees are fair and in line with others in our area. For an estimate of your healthcare expenses, get essential information on the costs of procedures, and learn insurance basics, please refer to fairhealthconsumer.org

How do dental insurance plans calculate what they reimburse you?

UCR & MAC… Here is what they mean

UCR or Usual and Customary  –  Well… the letters in UCR stand for Usual, Customary, and Reasonable. Almost sounds like the Insurance company is doing extensive surveys of dental fees in your zip code and then taking the average, but guess what? That is not what the Insurance company does. Insurance companies calculate the UCR differently, but it’s usually between the 50th and 80th percentile of dentists’ fees in a geographical area.

The UCR fee guide generated by the insurance company is a price they will allow for every dental procedure they cover. This is not based on what a dentist charges but on what the dental insurance will cover for the premium your employer wants to provide.

MAC or Maximum Allowable Charge – If your policy uses a MAC fee schedule, your employer determines the maximum allowable fee per procedure. Some hire an actuary to assist in this determination to ensure the employer’s benefit budget is met. The MAC is generally determined by the cost of the premium for the plan selected by the patient. This is why it differs greatly from plan to plan within the same company.

To further complicate things, the Insurance company only covers a % of their UCR or MAC fee. From its inception, dental benefits were meant to allow for some patient out-of-pocket expenses. Amazingly, the UCR / MAC fees can vary between insurance companies and different employer-sponsored plans at the same company. This is because dental benefits and the associated UCR/MAC fee schedule are determined by the negotiations between the insurance company and your employer. Your employer has likely selected a fee schedule corresponding to the premium cost they desire.

All MAC/UCR fees used by plans are proprietary information and typically cannot be obtained by the provider or patient. You can try. We encourage you to call your dental plan (number on the back of your insurance card) or talk directly with your HR or benefits department at work and request your MAC / UCR fee for the dental procedures in question.

Insurance worksheet

Click to download a print-ready version of the worksheet below

Preventive Dental Services- Routine dental procedures like cleanings and x-rays are considered preventive or diagnostic services. As the name implies, preventive care services help maintain good oral health and identify possible problems early, saving you from pain and greater expenses later.

Common Preventive Dental Services & Their CDT code (billing codes)

Examinations               CDT 0120 & 0150
Dental cleanings          CDT 1110 & 4910

% of PREVENTIVE my plan will cover___________________________________________

Basic Dental Services-When you get into restorative work like fillings, you move beyond preventive care and basic dental services. Just remember, preventive work stops potential problems or corrects them early to get your oral health on the right track; basic services are restorative work to fix the damage that has already occurred.

 A Common Basic Dental Services CDT code (billing code)

Composite Fillings (code depends on how many surfaces are diseased) codes for anterior teeth are CDT 2330, 2331, 2332

% of BASIC my plan will cover_________________________________________________

Major Dental Services-Complex dental work and surgical procedures, like implants, are classified as major dental services. These services are often lengthy or complex procedures to address issues that may have been caught and mitigated by earlier preventive care.

 A Common Major Dental Service

Porcelain Crown – CDT 2740

% of MAJOR my plan will cover___________________________________________________

questions to ask my plan or HR department about these codes specific to my health:

 

CDT CODE____________________________________________________________

MAC or UCR reimbursement $ from my plan_____________________________

% coverage on the UCR / MAC___________________________________________

CDT CODE____________________________________________________________

MAC or UCR reimbursement $ from my plan_____________________________

% coverage on the UCR / MAC___________________________________________

CDT CODE

MAC or UCR reimbursement $ from my plan_____________________________

% coverage on the UCR / MAC_______________________________________________

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