Fuller Dental files dental insurance as a complimentary service for our patients. Simply provide us with up to date dental insurance information at each visit and we will file your insurance claims and provide follow up information to any rejected claims to maximize your dental insurance benefit. However, after 60 days the patient is responsible for any balance on their account.
Our insurance coordinators will be more than happy to assist you in understanding the limitations of your dental insurance plan and obtaining an estimate of benefits.
PLEASE UNDERSTAND that 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 cannot be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.
Dental Insurance Facts:
Fact 1 – 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. 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. For non-preventive dental treatment, we will ask you to pay 20% of the treatment at the time the service is rendered.
Fact 2 – Benefits Are Not Determined by Our Office
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 exceeds 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 “reasonable.”
Why is there an annual maximum on my benefits?
Maximums limit what a carrier has to cover each year. Amazingly, despite the fact that costs have steadily increased, annual maximum levels for dental care have changed very little since the 1960’s.
Why do some plans require me to select a dentist from a list?
Usually the dentists on the list have agreed to a contract with the benefit plan. These contracts have restrictions and requirements. Some dentists are not comfortable with these restrictions and requirements and therefore do not participate in these types of contract plans.
What should I do if my insurance doesn’t pay for treatment I think should be covered?
Because your insurance coverage is between you, your employer, and the insurance carrier, Fuller Dental does not have the power to make your plan pay. If your insurance doesn’t pay, you are responsible for the total cost of treatment. Sometimes a plan may pay if patients send in the claims for themselves. The employee Benefits coordinator at your place of employment also may be able to help. Consumers (patients) may also lodge complaints with the State Insurance Commission.
MOST IMPORTANTLY, please keep Fuller Dental of Burlington, NC informed of any dental insurance changes such as policy name, insurance company address, or a change of employment by calling 336-790-9508 or faxing a copy of your dental insurance card to 336-226-0137.