Financial Information

There are so many variables with insurance coverage (i.e. deductibles, maximums, alternate benefit clauses, waiting periods—just to name a few) that all estimated copayments we calculate are truly ESTIMATED. We base the quote we give you for your copayment off the information your insurance company gives us. Each conversation with your insurance starts with a disclaimer: “They DO NOT GUARANTEE any information.” We give you our honest interpretation of the information they share with us.

The percentage your insurance company states they will pay is off their fee schedule, which may or may not match our charges. Each insurance company can have its own fee rate called a usual customary rate (UCR). Each dental insurance plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed, and cost of living. Each insurance company may also have a separate UCR for each employer they cover.

The missing tooth provision means that if you have a tooth missing when you start your current dental insurance coverage they will not cover the cost of replacing that tooth, whether through a bridge, denture, or other prosthetic.

If you are not able to participate in a group plan (usually through an employer) there are individual plans available. We have a brief list of companies, but an insurance broker could give you a more complete selection. Each one has its own benefit limitations, so read the fine print carefully before enrollment. Call to make an appointment to review the information on the plans you are interested in, we are glad to help you interpret their level of benefits.

If your insurance doesn’t pay for all of the treatment, the copayment is the cost you are responsible for. The deductible is the amount you must satisfy before your insurance company will begin paying benefits. The amount of the deductible, if your plan has one, is dictated by the benefit package you have.

An annual maximum is the maximum amount your dental plan will pay in benefits during the calendar year or plan year. Most companies select calendar year, which is January 1 through December 31; however, some select a plan year that corresponds to when their group’s benefits renew (or open enrollment). Some employers use a dental benefit program that runs from month to month, based on the number of hours you work. There are many variables when it comes to insurance companies and the benefits they offer. It is very important to know your dental benefits and when they renew. We gladly offer our assistance in understanding your dental plan.

Once your insurance company has paid benefits totaling the benefit maximum, they will not pay any additional benefit dollars until your next benefit year begins.

If you have orthodontic coverage, some dental plans have a separate policy for those benefits and some include it in the general dental coverage.