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! Most plans only pay 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.
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee. 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.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable.
These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. Frequently, this data can be three to five years old and these "allowable" fees are set by the insurance company so they can make a net 20%-30% profit.
Unfortunately, insurance companies imply that your dentist is "overcharging", rather than say that they are "underpaying", or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150. Assuming that the insurance company allows $150 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. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100, or $80. Out of a $150 fee, they will pay an estimated $80, leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays only at 50%, then the insurance benefits will also be significantly less.
Most importantly, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
Insurance Accepted by Orthodontist in Jacksonville, FL
Regular dental care is important for children and adults alike, but it can be difficult to pay for at times. When you visit our dentist or orthodontist in Jacksonville, FL, you have several payment options including CareCredit financing, private insurance plans, and private payment. While our clinic works with a wide range of dental insurance plans, there may be some cases where our clinic is not in your insurance network. In these cases, our kids dentist in Jacksonville, FL, will help you fully understand your financial obligations.
Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan that fits your timetable and budget, as well as gives your child the best possible care. Weaver & Stratton Pediatric Dentistry & Orthodontics accepts cash, personal checks, debit cards and most major credit cards. We also accept CareCredit.
Our Office Policy Regarding Dental Insurance
If we have received all of your insurance information on the day of the appointment, we will be happy to file the claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount that your insurance is not expected to pay. By law, your insurance company is required to pay each claim within 30 days of receipt. Our clinic in Jacksonville and emergency dentist in Orange Park, FL, file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 30 days of our billing, a $10 re-billing fee will be added to your account each month until paid. If you haven’t received a statement after 30 days, please call our office or log into your account to see if your insurance has paid and if you have a balance due. We will be glad to send a refund to you if your insurance pays us.
Is Weaver & Stratton Pediatric Dentistry & Orthodontics In-Network with My Insurance Company?
Our kids dentist in Jacksonville, FL is in-network with many insurance companies. Just because we are in-network providers for these companies, your out-of-pocket expenses will vary based on the level of the plan your employer has chosen. We are proud to be in-network pediatric dental providers for the following commercial insurance companies:
- Delta Dental
- MetLife Dental
- Aetna Dental Insurance
- Cigna PPO
- United Healthcare
- Assurant Dental
- And More . . .
We are always in discussions with other insurance companies about becoming in-network providers. If you have any questions about whether or not our practice is in-network with your insurance company, please do not hesitate to give us a call.
What if Weaver & Stratton Pediatric Dentistry & Orthodontics Is Out-of-Network?
In many cases, and depending on your insurance plan, your out-of-pocket expense for bringing your children to our office maybe even less than if your insurance company was in-network. Just like if your plan is in-network, your deductible, co-pays, etc. will vary greatly depending on the level of insurance plan your employer has chosen.
Please understand that our emergency dentist in Orange Park, FL, files dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. Once again, we file claims as a courtesy to you.