Billing & Insurance

The primary goal of an insurance company is to make money; the less they pay out in claims, the more profit they make.  Frequently, insurance companies will state certain information was not received in order to delay or avoid paying a claim.  For the policyholder’s benefit, we digitally document what was sent to the insurance carrier and when it was sent.  Insurance companies are required by law to pay a claim within 30 days of receipt, so we file the majority of claims electronically to expedite the process and get the claim in their hands within a matter of days.  If the insurance company pays us directly, we will promptly send you the funds.

A common misconception is that dental insurance pays 90-100% of all dental fees.  In reality, insurance plans typically only cover 30-80% of the average fees and in certain cases, reimburse the policyholder for less than the actual dentist fees incurred.  Your reimbursement is therefore dependent on the policy you choose, how much coverage is elected, or any contractual agreement that is established between your employer and insurance company.

In cases where the dental insurance company reimburses you for less than the actual dentist fees incurred, the insurance carrier will often argue that your dentist charged fees that are higher than what is considered usual, customary, or reasonable (UCR).  This is misleading and can give the impression that your dentist is overcharging rather than your insurance carrier acknowledging their benefits are low or they do not want to pay the full amount.  Policyholders should know that UCR is determined by the insurance company based on what they want to pay for and desire to be profitable rather than having anything to do with the dentist’s specific fees relative to the region.