Dental Insurance
DENTAL INSURANCE:
If you have dental insurance, as a courtesy, our office will process your insurance claims, in most cases, electronically. Since each plan varies considerably, we cannot always accurately assume what your insurance will cover, but we will try our best to help answer any questions you may have. The final responsibility for payment is yours.
Because the insurance company will not guarantee the coverage, we can only provide an estimate for you. We treat you and not your dental insurance company, so it is your responsibility to pay anything that your dental insurance doesn't. Your portion of the bill can be paid by cash, check or credit card.
Our office is considered "Out of Network" with all insurance companies EXCEPT for Delta Dental. We are now a preferred provider for Delta Dental. Check with your insurance to make sure you can go to any dentist of your choice.
PPO. A PPO
is a network of dentists contracted to provide care at specific rates.
Some PPO's pay only for dentists within their network, while others let
you see your dentist outside their network. Depending on your
particular PPO plan provisions, if you seek care from a dentist outside
their network, you will either not receive any coverage at all, or you
would simply exceed the allowance, and pay the difference for higher
quality. Our office does not participate with any dental insurance
companies networks.
DHMO. We currently do not accept patients with DHMO
insurance plans.
Payment.
Most insurance companies have their own fee schedule, and they pay the
percentage stated in your policy according to their fee schedule. They
do not pay according to our fee schedule. We do our best to estimate
what your plan might pay for recommended treatment, and while we are
accurate most of the time, it is only an estimate. Most plans require
deductibles and co-payments, and whatever portion of the bill not paid
by insurance is your responsibility, as prescribed in their explanation
of covered benefits and payment due for each claim filed, frequently
referred to as the Explanation of Benefits (EOB). We file claims for
you as a courtesy, but we have no control over your insurance
contract or their payments.
Usual, Customary and Reasonable Fees (UCR). This
payment method sets a maximum fee amount allowed for treatment, then
pays 50%-80% of that fee. You pay 20%-50% of that fee, plus the upgrade
difference between that fee and the cost of treatment. For example, if
a crown cost $1200, and your plan UCR fee is $910, and pays 50% of that
UCR fee, the plan will pay $455 ($910 X 50%), and your portion would be
$455 + $290 ($1200-$910) = $745.
Cost vs. Benefit. Dental insurance never pays 100% of
care. Otherwise, you likely could not afford the extremely high cost of
premiums without very high deductibles and co-payments, and very limited
annual maximum benefits. Generally speaking, you get what you pay for:
the greater the benefit, the higher the premium. If you want the
insurance company to cover each and every dental treatment, you will pay
a much larger premium than if you have lesser dental coverage. This is
why many plans exclude newer technology, treatments and materials that
they label as "discretionary or elective",
rather than "medically necessary dental care".
Because they are higher quality, they cost more than older technology,
treatments and materials. Examples of frequent exclusions from dental
plans are implants, porcelain veneers, white fillings, bonding, laser
surgery, laser gum treatment, whitening, fluoride treatments and some
periodontal care. In order to lower premiums, more and more employers
and patients are choosing plans with higher deductibles and co-payments,
more exclusions, and more limited annual maximum benefits.
Example of Decreasing Benefits. Dental insurance
coverage maximums have not kept up with the times. In 1960, a typical
annual maximum benefit was $1,000. Fifty years later, many plans still
offer that same maximum, but to stay up with inflation, that $1,000 in
1960 would have had to increase to more than $6,500 today. What that
means for you is that your insurance plan requires you to pay more and
more out of pocket each year to keep insurance premiums affordable.
114 Sproles Dr. #103
Benbrook, Texas 76126
(817) 249-5522