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Insurance Companies - Do they provide inexpensive care or are they in business with your healthcare Print E-mail

Our primary objective is to provide high-quality dental care at a fair fee while the insurance company's primary objective is to earn a profit for its shareholders.  Yes, we are in business to earn a profit too, but we cannot allow the insurance company to dictate the standard and quality of care delivered to you.  Therefore, we would like to share some information about dental insurance with you.

A common point of confusion is about how an insurance company determines UCR (Usual and Customary).  Inflammatory information is often sent by the insurance companies which may state our fees are higher than usual and customary.  An insurance company surveys a geographic area, calculates an average fee, takes 80% of that fee and considers it customary.  Included in this survey are discount dental clinics and managed care facilities, which bring down the average.  Many plans tell their participants that they will be covered "up to 80 percent or up to 100 percent," but do not clearly specify plan fee-schedule allowances, annual maximums or limitations.  In fact, “80% of UCR” many times is not even calculated by the fees in the area but instead is some arbitrary number so the company can sell the plan to your employer at a specific cost per person.  Hence, it may not represent a practical fee for a given procedure.   It is more realistic to expect dental insurance to cover 35 - 65% of major services.  Remember the amount a plan pays is determined by how much the employer paid for the plan.  You get back only what your employer put in, less the profits of the insurance company.  Dental benefits differ greatly from general health insurance benefits.  In 1971, your dental-insurance benefits were approximately $1,000 per year.  Figuring a 6% rate of inflation per year, you should be receiving $4,549 per year in dental benefits.  Your premiums have increased, but your benefits have not.  Therefore, dental insurance is never a pay-all; it is only an aid or supplement.

 The cost of handling insurance within our office includes numerous lengthy phone calls, resubmitting information or radiographs (x-rays) two or three times because insurance companies "lost" or "never received" them, excessive paperwork, mailing and redundant billing.  Hence, the cost of handling insurance is not trivial and really is substantial.  Patience is involved since it takes at least 1 month for claims to be processed, it’s not unusual for 3 months and sometimes longer!  Therefore, non-payment, excessive correspondences and delays may be passed on to the patient.