All About Insurance - Von R. Tracy, DDS
Helping to make oral health care more affordable
Dental insurance is a safety net that can make care affordable, but keep in mind that most plans cover only a portion of its actual cost. To keep their premiums competitive, carriers may restrict their benefits by limiting the number of covered procedures, by determining benefits based on only a percentage of the actual fee, or by calculating their reimbursement using unrealistically low fee schedules. Cleanings are often covered at or close to 100%, but payment for other services may range from 0% to 85% of the actual fee.
Higher reimbursement for preventive care can create a strong incentive to maintain your schedule of regular check-ups. At those times when more comprehensive care is necessary, insurance can give you the flexibility of financial freedom to be able to choose from among the best treatment options.
Even with insurance, you will almost always be faced with a remaining balance after benefits have been received. This motivates our practice to offer a variety of attractive payment options so that you can meet your financial obligations while maintaining uninhibited access to care.
Keep in mind that annual eligibility cycles create recurring windows of opportunity to find ways to take maximum advantage of your available benefits.
Insurance can be confusing, and there may be times when claims are rejected for what seem to be clearly covered procedures. When you have questions about the denial of benefits for proposed treatment or for treatment already provided, or if you have other concerns about a service that you believe should be covered by your plan, we will work with you as an advocate to achieve a satisfactory resolution with your carrier. However, it is your responsibility to pay for treatment you have already received, even as we explore possible avenues of appeal.
Our helping hand: Since dental insurance rarely covers the total cost of care, we will help you understand the included, excluded, or restricted coverage of your plan, and then work through its limitations as best we can.
Dealing with insurance carriers: You may already have discovered that plan provisions often defy logic, which may lead to our mutual frustration with the carrier.
Fees and U.C.R.: Your benefits may be tied to a fee that has been unilaterally determined by your carrier, linking benefits to its own unrealistically low version of “usual, customary, and reasonable fees” or U.C.R. Don’t be misled by such insurance company jargon.
Deductible: Some plans have a deductible that may be payable at the time of service.
Pre-authorization: Before using your insurance benefits, we will determine if proposed services require prior approval.
Maximum benefit: We are very good at monitoring plans to help you reduce your total out-of-pocket expense by taking advantage of all your benefits before the end of each twelve-month eligibility cycle.
Statement of services: If your plan allows you to file your own claim, we will provide you with a statement that clearly explains the treatment you have received.
Elective care: When you desire cosmetic dentistry that falls outside the carrier’s reimbursement guidelines, we will explore ways to secure alternative benefits.
Assignment: Benefits are generally assigned to our office. When they cover only a portion of the cost of your care, you will receive a statement for the balance that is due. Since we are prohibited from waiving any of the submitted fees, we cannot accept an assignment of benefits that would preclude us from receiving full payment.
Eligibility: Anticipated benefits can generally be verified by our business manager, but it is always a good idea for you to confirm beforehand with your employer your eligibility for coverage.
Assistance: We are accustomed to resolving the concerns of our patients, so feel free to inquire about any matter relating to your insurance.
We are PPO Providers of:
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