Dental Insurance
Our Office Policy Regarding Dental Insurance
Gwinnett Family Dentistry works with most PPO insurance companies and we are an out of network provider. Please contact your insurnace company to learn more about how much they cover for out of network providers. We do not work with Medicaid.
If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of your treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid for it or not. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until the outstanding balance is paid. We will be glad to send a refund to you if your insurance pays us.
Please understand that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, we are not responsible for how your insurance company handles claims or for the benefits they pay on any given claim. We can only assist in estimating your portion of the cost of treatment. We do not guarantee what your insurance will or will not do with each claim. We are not responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.
No Insurance Pays 100% Of All Procedures
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, but 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 your insurance company.
Benefits Are Not Determined By Our Office
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 is not accurate.
Insurance companies set their own benefits, and each company uses a different set of fees they consider reasonable. These ‘reasonable fees’ may vary because each company collects fee information from the 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 fees are set by the insurance company so they can net a 20-30% profit.
Unfortunately, insurance companies can 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 reasonable (UCR) figure.
Deductibles & Co-Payments Should Be Considered
When estimating dental benefits, you should consider deductibles and percentages, too. To illustrate, assume a service fee is $150.00. In this scenario, you can expect that the insurance company allows $150.00 as its usual and customary (UCR) fee, and from there, we can figure out what benefits will be paid. First, a deductible averaging $50 is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00, leaving a remaining portion of $70.00 to be paid by the patient. Of course, if the UCR is less than $150.00, or your plan pays only 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 so that we can best help you with your dental service needs!