Insurance, Preferred Providers, & Dental Insurance
How Dental Insurance Works
Some of our patients have dental insurance coverage as a benefit of employment and some patients pay for coverage on their own. Dental insurance is a contract that is made with your employer and an insurance company. The insurance company has negotiated the benefits you receive under the terms of the contract, not Glaser Dental or our office. No relationship exists between our office and the insurance company.
In some cases, treatment that you need or want may not be covered by your insurance plan. It is also likely that the treatment covered by your insurance is not paid at 100%. You may also have a deductible that you must pay each year. If your deductible has not been met by the time of treatment, it will be included in your share of the payment.
What We Do To Help
We have extensive experience in helping you obtain the highest level of benefits to which you are entitled. We will use all of our resources to get as accurate an estimate as possible for your treatment. As a courtesy to you, we will submit your dental insurance forms for you. All forms need to be complete and we require a current copy of your insurance card. It is your responsibility to inform our office of any changes to your insurance prior to any treatment. Because the insurance reimbursement process is often very complicated, please understand that we may need to request your assistance in certain cases to help us process your claim. In rare cases and despite our best efforts, our office may not be able to resolve every issue with your insurance company.
We Will Work With Dental Insurance Plans
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 in regards to your specific plan.
Dental Insurance In-depth
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. There is almost always a co-payment due from the patient for almost every procedure.
- There are “deductibles” in almost all plans. At one time these deductibles were never taken out of preventive treatment (“exams, x-rays”). 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 is solely dependent on the dental insurance plan purchased by the employer. The higher the premium the employer pays, 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 absolutely no power or leverage to deal with the insurance carrier. Only the employee or the contract purchasers has that power. Any complaints about benefits, payment, or coverage should be directed to Human Resources or the
- The letters “UCR” on insurance vouchers stand for Usual, Customary, and Reasonable. The dollar amount you see as UCR has no basis in reality. It is an arbitrary amount determined solely by the plan selected and 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 will be.
- A single insurance carrier may have a dozen different UCR fees for the same procedure, same office, and same dentist.
- There is no universal coverage and payment schedule 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. There are many dental procedures that are necessary,
and many of them are preventive, but are not covered benefits.
- Your dental benefits almost always have a yearly maximum contribution level. This amount is the most your insurance carrier is contractually obligated to pay during a defined year (calendar or otherwise). When this amount is reached, there will be no
further dental benefits payable until the next benefit year. If you have already begun some additional dental treatment prior to the maximum being reached, the insurance carrier has no payment obligation beyond that of the annual maximum.
- Insurance benefits cannot be saved and carried over into the next year.