Our Practice: Dental Insurance

To our Patients ... about dental insurance

     During the past decade, dental insurance plans have become an integral part of health care planning for many families. Dental benefits are made available to employees or members, through companies, unions, and assocations, and may vary considerably from one plan to the next. We are now a Delta Dental Premier Provider, part of an excellent national network of dentists.

     Dental insurance benefits are subject to deductible and plan maximums at the time services are rendered. Usually the maximum allowable charge is 10-20% less than the actual fee that you pay. Often referred to as "UCR" fees, the insurance benefit is based on a fee schedule that they claim is "usual, customary and reasonable". Thus the U.C.R. fee is a fee "cap" to limit the benefits available to you. Combined with deductibles, co-insurance and exclusions, dental insurance may cover only 30-50% of actual dental costs for the average dental claim, especially for major dental work (like crowns, dentures, root canals, etc.).

     Based on a fee survey in 1997, published by the North Carolina Consumer Council, the median fee for a single procelain crown in Chapel Hill was nearly 20% more than insurance company's average maximum allowable charge (U.C.R.) for the same period. We have noticed that most common annual maximum benefit for $1500 has not changed for over 20 years. On the other hand, why have dental insurance and not utilize this valuable benefit. If your first thought is "it's such a hassle," we hope that we can help because:

1. If you have dental work that you need and you don't maximize benefits paid you, the unused balance does not carry over to the next year. So the cliche "use it or lose it" applies. In such cases you are the primary loser. We can help you maximize your dental insurance benefits.
2. Frequently dental insurance in combination with a second financing or insurance plan can make preventive dental care a real bargain in the long run.
3. We have the experience to guide your dental care to avoid "claim denied" pitfalls and assure that you get benefits with relatively little effort on your part.

     If you have dental insurance, we can work with you to simplify the filing of your claim. Experience has taught us that accepting assignment of benefits for routine dental work carries too high a risk of patient dissatisfaction because of inconsistent processing systems used by the dental insurance companies.

     For routine dental work, with a little help, your insurance claim is easily prepared by you. Only fill in the "patient section" of the claim form including your signature and date. You simply write "see attached" across the "dentist section" at the bottom and attach you "walk out" statement that you receive with your payment. Mail the claim form and walkout statement immediately to your insurance company. The check for any applicable benefits should be received by you in approximately three weeks. If you use a credit card for payment you usually have already received your insurance check by the time the credit card payment is due.

     With major dental work you can authorize assignment of benefits while you pay only the portion of the fees not covered by insurance. A pretreatment estimate of benefits* determines the amount that you pay. With a $50 deposit we will determine the exact benefit that is provided for the dental services agreed upon. With insurance approval, you pay only the portion of the fee that is not covered by insurance on the day dental treatment begins. If unexpected services are required to complete your dental care, the charges would usually be paid on the day provided. Routine insurance claim procedures would be followed and the patient receives the allowable benefit from the insurance company.

     We hope that you will feel free to discuss insurance or other financial options available. Often your questions help us improve our services to you.

     Thank you for allowing us to serve you.

Sincerely,

David E. Boaz, D.D.S.
          and staff

• A pretreatment determination/estimate of benefits is sometimes desirable (but rarely required) before starting dental work. We have found that dental claims are valid with or without pretreatment authorization even for major work. It is not unusual to start major dental work where delay for "authorization" is not possible due to pain or cosmetic emergency. If in doubt, a call can be made to determine if insurance benefits are jeopardized by not completing the predetermination process.
• We are a participating provider with Delta Dental, the largest dental network in the state.

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Copyright 2006-2008 David E. Boaz, D.D.S. - Tender Loving Care