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Whether you’re new to our practice or have been a valued patient for years, it’s important to be reminded how most dental insurance plans work. Sometimes you may wonder why your insurance doesn’t cover the entire cost of your dental procedure or why it covers some dental procedures and not others.
Indemnity plans that have usual, customary and reasonable (UCR) plans built into them allow patients to see the dentist of their choice. This is also known as a PPO plan. These plans pay an established percentage of the dentist’s fee or pay either the plan sponsor’s customary fee limit or reasonable fee limit, whichever is less. Although these limits are called customary, they may or may not reflect the fees that I or other area dentists charge. Another type of plan is an HMO plan. If you have one of these plans, you are required by the Insurance Company to go to one of their HMO Dentist's. We do not accept any HMO Plans here in our office.
Sometimes it may be noted on your bill the fee that I have charged you is higher than the reimbursement levels of UCR. This does not mean that our office is overcharging you it means that the insurance company may not have taken into account up-to-date, regional data in determining a reimbursement level.
The plan purchaser at your workplace makes the final decision on maximum levels of reimbursement through their contract with the insurance company. Even though the cost of dental care has significantly increased over the years, the maximum levels of insurance reimbursements have typically remained the same since the late 1960s.
Your dental insurance plan may want you to choose your dental care from a list of their preferred providers. Whether or not you choose your dental care from this defined group can affect your levels of reimbursement. Your plan may also stipulate that they will pay benefits for the least expensive alternative treatment for a condition, or deny coverage for conditions that existed before you enrolled in the plan.
I hope this letter gives you a better idea of why your insurance may not pay 100% of your dental costs. If you have specific questions regarding your plan or if a specific procedure will be covered, I would advise you to contact your insurance provider for details. As always, thank you for being a valued patient.
We are currently a Preferred Provider for the following Insurance Companies:
- Delta Dental Premier
- Blue Cross PPO 300
- Cigna PPO
- Guardian PPO
- Principal PPO
- Connection Dental Network PPO- This is a network that many companies go through such as GEHA, Aetna Dental, and United Healthcare.
- Assurant Employee Benefits
We are also currently in the process of signing up with a few other companies, if you have any questions please call the office and speak to our Insurance Specialist @ 858-485-0200. Thank you!