If you have dental insurance we will gladly submit your claim on your behalf. We work hand in hand with you to maximize your insurance reimbursement for covered procedures. However, we cannot guarantee any estimated coverage, as the insurance policy is an agreement between you and your insurance carrier. There are many ways in which dental plans are designed and how reimbursement levels are determined. You need to know how your dental plan is designed, and its limitations.
Your Dental Plan is designed to share your dental care costs. It may not cover the total cost of your bill. Most plans cover between 50% and 80% of dental services; however, several factors can reduce the actual benefit you receive. These factors include the following: deductibles, annual limits, and maximum allowable amounts per procedure.
The contract your employer negotiated with your insurance carrier defines your dental benefits. We will verify your insurance prior to your appointment time. Please call (616) 249-3500 if you have any questions or concerns.
What is “UCR” (Usual, Customary, Reasonable) and how is it determined?
“UCR” is the term used by insurance companies to describe the maximum amount they will allow for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR, and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fee that the plan will pay, often based on many factors including region of the country, number of procedures performed, and the cost of living.
Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the benefits available from your dental insurance.
- Your insurance plan paid only a percentage of the fee charged by your endodontist.
- The treatment you needed was not a covered benefit.
- You have not yet met your deductible.
- You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
- Your plan may want you to choose your dental care from a list of their preferred providers.
- Specific plan limitations, like the re-treatment of an existing root canal.
Why isn’t the recommended treatment a covered benefit?
Your endodontist diagnoses and provides treatment based on professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
How do I know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit, and other factors. Ultimately, the patient portion is not known until your claim has been processed by your insurance company.
Will I receive notification of how much my insurance company will pay?
Your insurance company will mail you an EOB (Explanation of Benefits) outlining the detail of your processed claim. The EOB contains the following information: UCR, patient portion, remaining benefits, deductible, and benefit paid.