How dental insurance helps you pay for dental treatment

When our office is a participating provider with your insurance , it means we have agreed to charge all patients who come to our office with that insurance, according to an insurance pre-set fee schedule. The patient is ultimately responsible for paying these reduced fees.

Besides arranging for you to get treatment at reduced fees, the insurance company also helps you pay these fees. They pick what procedures they pay for and how much they pay for each one. This is called your breakdown of benefits and can differ from patient to patient depending on the kind of benefits your employer has arranged for you.

At the treatment visit, we estimate the amount that insurance will pay based on your breakdown of benefits and charge you the remaining portion of the fee. This is your co-pay.

After the treatment has been done, our office does all the paperwork and submits the payment claim for your treatment to the insurance company at no cost to you.

The insurance company then processes the claim and sends us their portion of the payment. The sum total of the insurance payment and your co-pay should equal the fee for the service. If the insurance company pays less than their estimated amount, we bill you the difference. If they pay more than the estimated amount, we credit you the difference. If present, this difference is usually only a few dollars.

The differences in estimated and actual payments may be due to specific clauses in that group plan, old claims being processed, and the maximum for the year being exceeded being some of the reasons. Pre-treatment estimates are never guaranteed by the insurance company – they are always considered estimates. It is only after the claim has been processed that we know the exact amount that has been paid by the insurance company.

We will always explain all your treatment options, help you to understand your payments, and utilize your insurance benefits to the maximum. We encourage you to call your insurance company as well, in order to understand the scope and extent of your plan.