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How Dental Insurance Works

Most dental offices can help determine coverage.

Dental offices are pleased to assist patients in maximizing their insurance benefits by determining insurance coverage and completing claim forms. As a courtesy, many offices ask patients if they prefer to pay only their estimated co-payment, awaiting anticipated insurance remuneration. Naturally, estimates are based upon the information available and cannot be guaranteed.

The range of benefits ranges widely with dental plans, as an insurance company may have hundreds or even thousands of differing policies, often customized according to the needs of the client. Plans may cover as little as 30% or as much as 100% of dental services, with most falling in the 40% to 80% range. Some plans base the amount of benefit on a schedule of fees arbitrarily developed by insurance companies.

For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the insurance company and not the actual fee charged by the dental office.

The financial obligation for dental treatments is between patient and doctor. The insurance company is responsible to the patient, not to the dental office. Most dental offices assist patients any way possible. Modern electronic claim filing systems speed the processing of claims so long as the insurance carrier is up to date.

Once an insurance company has fulfilled its obligations, any difference is customarily due upon receipt of the statement. Many offices consider payments delinquent if insurance processing exceeds ninety days. Outstanding balance may become due and payable and are sometimes subject to a finance charge.

While relationships among carriers, patients and dental offices have improved in recent years, dental insurance has been a source of frustration for doctors and patient alike, virtually since its inception. To minimize out-of-pocket dental expense, avoid the pitfalls of insurance fine print, and to maintain doctor-patient rapport, patients are encouraged to learn the nuances of their coverage prior to treatment.

Want a great dentist who can help you with all of your dental needs? Call us at 1-866-970-0441 today.

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