If we’ve received all of your insurance information at the time of service, we’re happy to file your claim for you. Please be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. If you do not have insurance, it is expected that you pay in full at the time of service. We accept all major credit cards, checks and cash.
No. Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true. As a general rule, the majority of insurance plans that we encounter in MT cover 100% of preventative care and between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company. We are happy to research your plan for you prior to performing treatment on your child.
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee, leaving you to pay the remainder. Frequently, insurance companies state that the reimbursement was reduced because your dentist's fee has exceeded the usual, customary, or reasonable fee ("UCR") used by the company.
It’s important to note, that insurance companies set their own fee schedules and each company uses a different set of fees they consider allowable. These allowable fees vary widely because each company collects fee information from claims it processes. The insurance company then uses this data to create their UCR fee for a given procedure.
Often times, parents are left to believe by the insurance company that the dentist is "overcharging," when in reality insurance is often "underpaying" or providing minimal benefits. In general, less expensive policies use lower usual, customary, or reasonable (UCR) figures. Again, it’s important to be familiar with your insurance policy to ensure you receive a benefit that matches the level of care you require for your children.
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00, leaving a remaining portion of $70.00 (to be paid by the patient).
Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.
If you have any questions regarding payment, insurance, or billing, don’t hesitate to call the office during regular office hours at (406) 541-7334.