Dental Insurance

Dental Insurance Coverage Explained

We love to see you in the office. We want to be your provider.

WE ACCEPT ALL INSURANCE PERIOD. However, we are no longer networked or in any relationship with Delta Dental.

If your plan has out-of-network benefits, we will continue to submit your paperwork, but how or if your specific plan will distribute your benefit will be unique to your policy. The insurance company may force you to visit someone on “their list” to receive the benefit you have invested in. Check your policy by calling the number on the card- your policy is specific to you. Unfortunately, the insurance company will not allow us to contact them on your behalf.

After much deliberation, we are ending our relationship with Delta Dental. Delta Dental underwrites Security Health Plan, AARP & other Medicare Advantage Dental Plans.

We stepped back from working with Delta on traditional employer-funded policies a while ago. At that time, we intended to stay in a relationship with their Medicare Advantage Program. Many of you have been with our team for years, and we greatly appreciate you! Therefore, we wanted you to receive the preventative care your Delta Dental plan afforded you. For that, we were willing to make concessions and continue the partnership with them.

Glaser Dental signed a contract, but partway into the contract term, Delta changed what they expected of our team. Adding these new covered services has significantly strained our small private practice. Big insurance companies are concerned about numbers, like a math formula for profit. Our interest is in caring for people. Providing the right solution for you, our patients – not limited by the variable of time or margin.

We are always here to answer questions and help you through this transition.

Alternatively, we continue offering our in-house dental plan, the Glaser Wellness Plan. This may be a great way to add cost savings to your care. The plan covers preventative care and provides members with additional perks. This cost-saving plan has become increasingly popular with those patients who do not want to deal with the insurance companies and their limitations to care. Click here for more details.

Sincerely,

Dr. Glaser and the Team @ Glaser Dental

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. A third-party healthcare organization, FairHealth Consumer (not your insurance company or us), supplies the information. It uses your Zip Code to determine the fair cash price.

Get Cost of Procedures

Dr. Glaser has always been and will remain open about his charges. We determine our fees by comparing similar practices in our area, considering the materials and technology used, and accounting for the continuous training required to provide the level of service we are passionate about. Keeping great care accessible and competitively priced is essential to Dr. Glaser.

Dental insurance FAQs

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

The member pays the out-of-network provider upfront. A reimbursement check is sent to the member’s home, typically within 14 days. 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. Initiating treatment doesn’t require predetermination. However, obtaining it will assist in determining coverage for a procedure and the amount the insurance company will pay. Your insurance company may take 4 to 6 weeks to provide the predetermination, and even then, it will 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 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 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 bill you for the difference between what your plan pays and the total 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.

An unexpected balance bill, known as “surprise billing,” can occur when you can’t control who is involved in your care—such as during an emergency or when scheduling a visit at an in-network facility but receiving unexpected treatment from an out-of-network provider. Depending on the procedure or service, surprise medical bills could cost thousands of dollars.

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. 

Dental Insurance In Depth

The plan you and your employer have selected and purchased varies greatly. Please call the number on the back of your insurance card for the most accurate and up-to-date information concerning your specific plan.

Below are a few facts to help you understand how dental insurance works.

  • Dental insurance benefits do not work in the same way as medical insurance. A co-payment is almost always due from the patient for almost every procedure.
  • There are “deductibles” in almost all plans. Initially these deductibles were never taken out of preventive treatment (“exams, x-rays”), however, recently many carriers have begun to take deductibles out of preventive treatment.
  • Irrespective of any dental insurance benefits that might exist, the patient is always legally responsible for the entire cost of dental treatment.
  • The extent of dental coverage solely depends on the dental insurance plan purchased by the employer. The higher the employer’s premium, the greater the dental insurance benefits.
  • Even if there is a written predetermination of benefits returned from the insurance carrier, it is possible that after treatment is provided, there are no insurance benefits payable.
  • We (the dental office) have no power to deal with the insurance carrier. Only the employee or the contract purchaser has that power. Any complaints about benefits, payment, or coverage should be directed to Human Resources or the
    company owner.
  • The “UCR” letters on insurance vouchers are Usual, Customary, and Reasonable. The dollar amount you see as UCR is an arbitrary amount determined solely by the plan selected and the insurance premium paid by the employee.
    There is no relationship to the actual dental office fee. The better the plan (i.e., the more premium paid), the higher the UCR.
  • A single insurance carrier may have a dozen different UCR fees for the same procedure, same office, and same dentist.
  • No universal coverage and payment schedule has been established. Just because an insurance code describing a dental service exists, it does not guarantee that it will be a paid benefit under your policy. Many dental procedures are necessary, and many are preventive but are not covered benefits.
  • Your dental benefits almost always have a yearly maximum contribution level. The is the amount the insurance carrier is contractually obligated to pay during a defined year (calendar or otherwise). When the maximum amount is reached, no further dental benefits will be payable until the next benefit year. If you have already begun some additional dental treatment before reaching the maximum, the insurance carrier has no payment obligation beyond the annual maximum.
  • Insurance benefits renew annually and cannot be saved and carried over into the following year.

How do dental insurance plans calculate what they reimburse you?

UCR & MAC… Here is what they mean

UCR or Usual, Customary, and Reasonable – It 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 the insurance company generates 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 premium cost for the patient’s plan. This is why it differs significantly 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 the negotiations between the insurance company and your employer determine dental benefits and the UCR/MAC fee schedule. 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 that the provider or patient typically cannot obtain. 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 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 more significant expenses later.

Standard 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. Healthcare providers often perform complex and lengthy procedures to address issues that earlier care could have prevented.

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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