Insurance and Financing

Insurance Information

How to switch to a new dentistWe would like to stress that our relationship is with you and not with your insurance carrier. As a courtesy service, we will bill your insurance for you and will send any necessary letters and pre-determinations. If your insurance carrier will send payment directly to our office, and if we can verify your coverage, we will bill your insurance and await payment. You will be asked to pay your estimated co-pay and deductible. You are responsible for any balance remaining after the insurance company has paid the claim. If we do not receive payment from your insurance company within six weeks, for any reason, full payment becomes your responsibility and is due at that time.

DO YOU ACCEPT MY DENTAL INSURANCE?

In most cases the answer is yes. If we can verify with your insurance company that you have coverage, and can determine the specifics of your coverage, we will accept the insurance. This means that we will handle the processing and billing of your insurance for you and will wait for the insurance to reimburse us. You will be asked to pay your co-pay and deductible (if any applies) at the time that the service is provided.

Of the hundreds of insurance companies our patients use, there are some who send payment to the patient. If your insurance sends payment to the patient, we will be happy to process your claim for you. You will be asked to pay the balance in full at the time of service and the insurance reimbursement will be sent to you. We will accept credit card payment. In many cases your insurance reimbursement will arrive before the credit card payment is due.

DO YOU PARTICIPATE WITH MY INSURANCE PLAN? ARE YOU IN-NETWORK?

“Accept” your insurance means that you can use your insurance in our office and receive reimbursement to the extent provided under your policy.

“Participate” with your insurance means that we have signed a contract with the insurance plan. This document requires that we accept greatly discounted fees in exchange for the employer/insurance company telling their employees/customers to come to us for service. We do not contract (in-network) with many insurance plans. In most cases if we are out of network you can still use your insurance in our office.

Link: Why we opt out of insurance networks

There are literally hundreds of different plans, and they constantly change their rules. For more information on using your insurance in our practice, please call us at (585) 335-2201.

NO INSURANCE, NO PROBLEM!

For patients without insurance, we offer a membership plan. This is an optional cost savings program based upon a flat monthly fee that covers your routine care at a discount, plus a discounted member rate on non-routine care.

Financing

Payment in full is expected at the time services are rendered unless previous financial arrangements have been made.

Payment may be made in the form of cash, personal check, MasterCard, Visa, or Discover Card. Extended payment options and financing are also available to assist our patients in being able to fit their dental care needs into their budget.

We will openly and honestly discuss all fees prior to providing the service and will gladly work with you to plan your dental care to fit within your financial picture.

Financing is available through CareCredit.

More About Insurance Terms

The following are some basic terms that will greatly improve your understanding of how your dental insurance works.

“Accepting” Insurance

At Dansville Dental Professionals, we accept most dental insurances. This means that if your dental insurance will send payment directly to our office, we will accept your insurance as payment and only request that you pay your deductible and co-pay at the time of service. We will handle processing the insurance forms for you and we will bill your insurance and wait for insurance reimbursement.

Deductible

This is an annual amount that your insurance requires you to pay before the insurance goes into effect. For example, if your deductible is $50, you must pay the first $50 each year yourself before the insurance will cover anything. Some insurance plans have a deductible per family member; others have a single deductible per family.

Participating Insurance

Most insurance plans offer contracts to dentists. The dentists agree to charge a reduced fee set by the insurance company in exchange for the insurance company encouraging patients to use that dentist. There are several very obvious problems with this concept of making a “deal” with the dentist to cut fees in exchange for more patients. It limits your options in choice of dentist and encourages you to use dentists who are possibly in need of patients and who may be willing to cut corners on quality or service so that they can afford to provide the service for much less money and still remain profitable. For these reasons and many others, we limit our “participation” to only a handful of companies whom we have carefully screened and selected based upon the coverage provided and the terms of the agreements.

Annual Limit

This is the maximal amount of insurance dollars the company will pay per family member per year regardless of the coverage percentages listed. For example, if you need $1,200.00 worth of dental care, and the insurance provides 100% coverage for that work, but you have an annual limit of $1,000, they will pay only $1,000 in any given year. They don’t pay that $1,000 until after you have paid your $50 deductible.

Typical limits are $1,000 or $1,500 per calendar year. Even though premiums go up every year and dental fees go up every year, these annual insurance limits have not increased since the 1960s. So each year the buying power and value of your insurance policy actually decreases. We will monitor your annual limit for you and do our best to inform you of where you stand. However, we cannot be aware of work that you have had done in other offices (including specialists that we referred you to) , and cannot monitor every insurance for every patient. You will need to keep an eye on your annual limits yourself – which should show on every insurance statement you receive.

Fee Schedule

UCR – The fee schedule (prices) set by the insurance company. UCR is an abbreviation for “usual customary rate.” Interestingly enough, the UCR varies greatly from company to company and has no connection with the real world. Caution is in order here. For example, if an insurance company tells you that they pay 100% of something, what they usually mean is that they pay 100% of THEIR fee schedule. Their fee schedule is anything they want it to be. So even if the insurance states that they pay 100% of a given procedure, you may still have a co-pay due. For example, if you have a cleaning and our fee is $40, and your insurance company pays 100% of their fee schedule of $35, you will still have a co-pay of $5.

Predetermination

Most insurance companies request a “prior” or “pre-determination of benefits” for any major work. In other words, even if the treatment to be provided is a covered procedure, the insurance carrier requires that documentation and x-rays be sent to them for review prior to providing the service. This is a great inconvenience to the patient and a great money saver for the insurance company. By stalling treatment, some patients do not follow through, and it also allows the insurance to retain their funds longer, generating more interest income. Many times, they “lose” predeterminations or request additional information, further delaying treatment for the patient. The end result is that needed and wanted treatment that should be paid by the insurance is typically delayed several weeks. However, if the predetermination is not done, or is not current, the insurance company has grounds for not paying the claim, even if it is covered under the terms of the policy. Another caution here is annual limits. Even if you have a pre-determination showing coverage for a given procedure, the insurance will not cover that procedure if you have exceeded your annual limit.

Co-Pay

This is the amount that the insurance company requires you to pay for any given procedure. For example, if your insurance covers fillings at 80%, and you have a $100 filling done, your co-pay would be 20% of $100, or $20. (Some offices will waive the co-pay – accepting the insurance payment as payment in full so that the patient pays nothing – this is insurance fraud and is illegal). Some insurances apply the deductible to preventive care; others do not.

Lifetime Maximum

Some insurance policies have now added a life time limit to coverage. Once you use up your life time limit, they no longer provide coverage.

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If you have any questions call us (585) 335-2201

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