Insight on Insurance
Here are some of the most common questions we get about insurance. Click on the question to reveal the answer.
WHY DOES MY DENTAL PLAN SAY IT COVERS CLEANING AT 100%, BUT MY DENTIST SENT ME A BILL?
Insurance companies operate from fee schedules. Remember that what insurance carriers call “usual and customary” is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment. It is usually less, and frequently much less than what any dentist in your area might actually charge for a dental procedure. It does not mean that your dentist is charging too much. Typically, there is always a portion of your charges that is not going to be covered by your dental plan.
WHAT IS A PRE-DETERMINATION?
A predetermination is a written request for verification of benefits for a specified procedure. Although it helps us determine your insurance company’s financial responsibility for your particular treatment, it does NOT guarantee their payment at the time of service. Variables such as deductibles, policy provision changes, and other claims submitted for payment, decreasing your maximum yearly benefit available, can all change the original authorized amount.
CAN I COME TO YOUR OFFICE IF YOU ARE NOT A PREFERRED PROVIDER?
Everyone is welcome at our office. We process claims from most dental insurance companies, and find that their coverage varies widely, depending on your employer established plan. We are always happy to help you understand your coverage, your out-of-pocket expenses, and will gladly submit your dental claims at no cost to you. However, we encourage you to determine if your specific plan requires you to seek your care ONLY within an established network of providers.
WHAT IS A PPO? (PREFERRED PROVIDER ORGANIZATION)
A PPO is a dental insurance plan that gives you the freedom to choose your dentist. Your benefits will vary between In-Network and Out-Of-Network providers.
WHY WON'T MY INSURANCE COMPANY PAY FOR THE TREATMENT MY DENTIST RECOMMENDS?
Dr. Chapman will always recommend the most appropriate care for you, based on diagnosis and consultation. Your insurance company will approve the least comprehensive approach, in an effort to control their costs. We will always believe that insurance coverage should not dictate treatment when it comes to our patients.