Understanding Dental Insurance Coverage

Receiving a bill for services that you thought were covered by insurance can be frustrating. While we try our best to include coverage estimates, sometimes insurance companies will deny certain claims or change their coverage options. So how do insurance companies determine what they will cover and how much? To understand this, first we must define some terms. UCR stands for Usual, Customary and Reasonable fees that the insurance will pay for dental procedures. Under this type of plan, called PPO, patients are able to choose any dentist who accepts this type of insurance. As part of the agreement between the insurance company and the provider, the dentist will adjust his or her fees to meet the fees set by the dental insurance company, which in most cases are lower than what the office would normally charge. For example, our office charges $95 for a Panoramic radiograph, but if a patient has Delta Dental insurance, he or she will be charged $64 because Delta Dental has set a UCR fee at that level and the dentist has agrees to those terms. Insurance companies may supply a list of Preferred Providers, which are dentists that take their plan, and going to a dentist outside of that list may result in the patient being liable for the difference. There is a large amount of variation between different insurance companies, so it is very important to understand what type of insurance you carry and how much they will cover for certain procedures. In addition to UCR, many insurance companies will set Annual Maximums, which determine how much treatment will be covered per calendar year. If the money is not used, it will not roll over to the following year and will be lost. Sometimes insurance companies will deny coverage for certain types of procedures, such as crowns and bridges, or preventative treatments such as sealants or Fluoride. This does not mean that these procedures are not necessary.  We always strive to do our best to provide a treatment plan to our patients and explain which procedures are recommended a why, the insurance coverage, and patient responsibility. If you have any specific questions about your treatment or payment options, please do not hesitate to call our office for help. We are always here to assist you with your dental needs. We love to see you smile!

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