- Patients without dental insurance
- Patients using dental insurance
- Frequently asked dental insurance questions
This section of our website provides information about dental insurance benefits.
We want you to understand how dental insurance works and how to make it work best for you. You should also understand how the treatment your endodontist provides works with your dental plan.
The contract your employer negotiated with your insurance carrier defines your dental benefits. Please read the benefit of insurance plan booklet provided by your employer so that you better understand your benefits. Various dental plans cover endodontic procedures at different payment levels and, as a result, your payment portion may vary. If you do not find the answers to your questions, contact your employer’s plan or benefits administrator who can explain the details.
Our experience with over 700 dental insurance contracts show us that misunderstandings most often occur concerning co-payments, (usual and customary fees) and “In network” and “out of network” providers.
- What is a “UCR” and how is it determined?
- Why was my benefit different from what I expected?
- Why isn’t the recommended treatment a covered benefit?
- How do I know what my payment portion will be if my insurance does not cover the entire fee?
- How do I understand my explanation of Benefits (EOB)?
- How long does it take for a claim to be paid?
- Will my endodontist take my insurance?
- “UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the benefits available from our dental insurance.
- Your insurance plan paid only a percentage of the fee charged by your endodontist.
- The treatment you needed was not a covered benefit.
- You have not yet met your deductible.
- You have not reached the end of your plan’s waiting period and are currently ineligible for coverage
- Your endodontist diagnoses and provides treatment based on his or her professional judgement and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan my not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
- Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance check has been received by your endodontist.
- Your explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan. The statement includes the following information: UCR, copayment amount/patient portion, remaining benefits, deductible and benefit paid.
- The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.
Endodontic Associates has signed contracts with several dental insurance carriers and agree to accept the payment offered by the insurance company, even though it may not be the same amount as Endodontic Associates charges for the procedure. This means we are Participating Providers in those plans.
Our reception staff can inform you of the plans we participate with. If we participate with your dental plan, you will be required to pay the estimated co-payment and your deductible if it has not been met, at the time of treatment.
There are some dental insurance plans that we do not sign contracts with but will still submit the claims and take insurance company payments as partial payment. For these insurance companies we are not Participating Providers. In this instance, you will be responsible for a payment portion over and above the percentage provided by your insurance company.
Our reception staff will inform you if we do not participate with your plan.
If we do not participate with your dental plan, we will still confirm your current status and benefits with your insurance company and submit your claim forms for you. You will only be required to pay the amount that is not covered by your insurance company.
Our staff will make every effort to verify your insurance benefit before your appointment.
The amount the insurance company states they will pay, is only an estimate that has been obtained over the telephone. Telephone verification does not guarantee payment from your insurance company. If we are unable to verify your insurance benefit you will be responsible to pay the full amount at the time treatment is rendered. We will continue to try and confirm your benefits and submit necessary claim forms for you.
If you would prefer, and don’t need immediate treatment, we can request a pre-authorization for treatment from your dental insurance company to find out the exact reimbursement for the procedure necessary. This may take approximately 2 weeks.
After receiving the pre-authorization from your insurance company we would then contact you to set up your treatment appointment.
What if I still have questions?
Our reception staff will do their best to answer all of your insurance questions. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss the matter with your plan administrator and explore appropriate alternatives.
Because of the nature of referral work and the high cost of extending credit, we must respectfully request that all patient balances be paid at the time of the actual treatment. If you are unable to pay for treatment upon completion, please advise us now. We realize that this can be a problem for some of our patients, if you need an extended period of time to make payments, we will be glad to accept Visa, Mastercard, Discover, American Express or CareCredit.
CareCredit is a credit line for dental expenses. It allows you to start treatment immediately and pay over time with low minimum monthly payments. CareCredit offers 3,6,12 & 18 month No Interest Payments Plans. They also offer 24, 36, and 48 month Extended Payment Plans at fixed monthly payments and a low 9.9% annual percentage rate.
If you have an questions about CareCredit, please contact any of our offices and our receptionist can help, or contact CareCredit directly at 1-800-365-8295.