If you have dental insurance we will gladly submit your claim on your behalf. However, we cannot guarantee any estimated coverage, as the insurance policy is an agreement between you and your insurance carrier.
No insurance pays 100% of all procedures.
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90-100% of all dental fees. This is not true! Most plans only pay between 50-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.
Benefits are not determined by our office.
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. This can be very misleading and simply is not accurate.
All of our fees have been accepted by Delta Dental (considered the standard for dental insurance companies), as usual and customary. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Your estimated co-payment is due the day treatment is initiated.
If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. We will file insurance electronically so your insurance company will receive each claim within days of the treatment. By law, your insurance company is required to pay each claim within 30 days of receipt. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. We will promptly send a refund to you if your insurance pays more than was expected.
Please understand that we file dental insurance as a courtesy to our patients.
We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance — once again, we file claims as a courtesy to you.
Most importantly, please keep us informed
Please inform us of any insurance changes such as policy name, insurance company address, or a change of employment.
Does your office accept my insurance?
- With an Indemnity Plan patients can choose their own dentist and their coverage remains the same.
- Within the Delta organization, we are a Delta “Premier” provider.
- With a “PPO” plan (Preferred Provider Option) coverage % is usually higher and deductible lower at a Preferred Provider. You need to check your individual plan to verify your options in and out of the network.
- We are a Preferred Provider for: Connection Dental.
While we do see many Blue Cross/Blue Shield patients, we are considered an “Out of Network Provider”. Blue Shield requires their patients to pay an out of network provider the entire fee at the appointment, then Blue Shield reimburses the patient according to their fee schedule.
- We are not a provider for any DMO plans.
- We are not a Denti-Cal or Healthy Families provider.
If you have a co-payment due at your appointment, as an alternative to paying with cash or a check we accept Visa, MasterCard and Discover cards.