Insurance Information

Things you need to know about your dental insurance:
  • Dental insurance benefits do not work in the same way as medical insurance. There is almost always a co-payment due from the paitent for almost every procedure.
  • There are “deductibles” in almost all plans. At one time these deductibles were never taken out of preventive treatment (ie: exams and x-rays). Recently, many carriers have begun to take deductibles out of preventive treatment.
  • Irrespective of any dental insurance benefits that might exist, the patiet 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.
  • 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 purchaser(s) has that power. Any complaints about benefits, payments, or coverage should be directed to your Human Resourses or the company owner.
  • The letters “UCR” on insurance vouchers stand for Usual, Customary, and Reasonable. It is an arbitrary amount determined soley by the plan selected and insurance premium paid by the employee. There is no relationship to the actual dental office fee.
  • 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 preventative, 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 can not be saved and carried over into the next year.