Do you accept my insurance and are you a participating provider of my plan?
We currently accept and file for most private care insurance plans, and this means that we work with hundreds of companies. All insurance plans are welcome at our office. We are participating providers with Northeast Delta Dental. This means that we are in-network and contracted with Northeast Delta Dental. Members of other insurance plans are very welcome, and their insurance will be accepted and filed on their behalf (out-of-network). If you are responsible for a co-payment, we require that this be paid when treatment begins.
How much will my insurance pay ?
Although we maintain computerized histories of payment by a given company, they do change and therefore, it is impossible to give you a guaranteed quote about insurance at the time of service. We "estimate" your portion based on the most up-to-date information we have, but it is only an estimate.
I thought I paid my portion, but I got a bill. Why ?
We base the patient portion of your bill on our most current insurance data, but there are several factors that can affect this estimate. For example, there may be a deductible, or you may have received treatment in another office prior to joining our office. Insurance companies do not inform us of any changes to your benefits. We do, however, investigate your benefits as thoroughly as possible.
Insurance did not pay, now what ?
We bill your insurance as a courtesy. Dental insurance is nothing more than a contract between your employer and the insurance company to partially pay for certain services. These dental procedures on the list of provided benefits are not based on need but are determined by your employer. Your employer buys a contract at a specified premium, and includes as many, or as few benefits as the employer is willing to pay for. It is a well known fact within the industry that a higher premium paid by the employer will get you, the patient, a higher "usual customary and reasonable (UCR)" benefit schedule.
Our fees are set by the actual costs of doing business in this office. Costs can vary from office to office depending on the quality of service, material used, lab costs, and many other factors. Our fees reflect the quality of service and the care with which it was delivered. Our diagnostic equipment, sterilization procedures, and restorative services are state-of-the-art. The fees reflect the quality of service and the care with which it was delivered.
An often misunderstood term used by many insurance companies is "UCR". This is an arbitrary fee maximum at which the insurance company will stop reimbursement. After this maximum, coverage for a particular procedure may cease, meaning that the patient will have an extra portion that is due. Despite our best efforts at giving you an accurate estimate, a patient will occasionally owe the amount of the difference. Again, this has nothing to do with the fee charged, but rather with the level of coverage negotiated between your employer and the insurance company.