We do our best to approximate your costs, but as each insurance company and policy is different, we cannot always know your exact cost until the insurance makes payment. Many times we have a history of what they will pay, but even this changes on a yearly basis. It is important to understand your policy and we can help facilitate this.
Dental insurance is a contract between your employer and a dental insurance company. The level of benefits that you receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company. Dental services are covered at a percentage by the insurance companies by what they call "Usual, customary and reasonable" fees. These fees are based on your premiums and negociated by your employer. Insurance companies, on an individual basis, come up with "usual and customary" fees for all dental procedures for a certain geographical area. When asked to see how the numbers were arrived at, the insurance company says that this is confidential, however say it is based on surveys of the area. However, if these fees are based on geographical areas and studies, why does EACH insurance company have different fees?
For example, if a $100 procedure is "covered at 100%" by your policy, each insurance company has a different "usual and customary" fee for that $100 procedure. Some companies may say that $90 is "usual and customary" and will only pay 100% of the $90 rather than the $100. In this case, $10 of the fee is paid by you out of pocket. This is not because dental offices are overcharging, but that the insurance company has negotiated with your employer and based on your premium have come up with what THEY feel is "usual and customary". This is different for EVERY insurance company and policy.
Donna, our office manager, is well educated on dental insurance policies and issues and can answer any of your questions. Feel free to call and find out about your policy today. You're paying the premiums so you should maximize the benefit of your policy by using it!