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Dental Insurance is intended to cover a portion of your dental treatments. The amount of coverage depends on the individual contract your employer or union has with the insurance carrier. In most cases, you are responsible for a deductible and the portion of the fee not covered by your contract.
Our trained staff will provide you with the necessary forms, supporting letters and other pertinent documentation that is required for you to submit your insurance claims for reimbursement. We ask that you collect your reimbursement from your insurance company, while we remain focused on providing the best dental treatments possible.
Dental insurance is intended to provide you money to pay for a portion of your dental treatment expenses. The amount of money provided depends on the specific contract that you, your employer or union established with the insurance carrier.
Here is some information that will help you better understand how dental insurance works
Usually, contracts have an annual maximum benefit (commonly ranging from $750 to $2,000). That is, the insurance company reimburses you, to the defined maximum amount, during the year that the contract is in force. These payments are in accordance with certain, specified modifying factors.
Factors that modify how much reimbursement you may receive are often numerous, and sometimes complex. One common modifying factor is the Deductible. The Deductible is the amount of treatment expense that you must pay, personally, before your carrier starts issuing benefits.
Another common modifier is the Usual, Customary and Reasonable Fee schedule. UCR Fee schedules are created by each insurance company, and are structured specifically for their policies and their purposes. A UCR Fee schedule is a list of treatment services that are covered by a contract, and how much the insurance company will pay for each of the listed treatments.
The title, UCR Fee implies that the fee that the insurance company will render for a service represents the appropriate cost of the treatment. However, in our experience, and in the experiences of most other practitioners with whom we speak, this is usually not the case. Insurance companies are in business to profit from the sale of their products and provide their stockholders dividends. Inherent to this end is a need to make their UCR Fees as low as possible without making their product commercially unattractive. Thus, the disparity between private practice fees and UCR Fees.
Unfortunately, the ultimate consumer - you - can not obtain UCR Fee schedules (in most states) when shopping for coverage prior to enrolling, or while being enrolled, in an insurance plan. This is the case with medical, as well as dental insurance. This can be changed if consumers demand that their legislators make it mandatory that UCR Fee schedules be made available.
For your convenience, here are links to local government officials and insurance commissions. Using these links, you can lobby to have insurance regulations in your state changed to better favor the consumer.
Government Sites
www.congress.org
www.house.gov
www.mec.state.md.us/
www.state.va.us/
www.dc.gov
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