PATIENT INFORMATION

Financial Policies/Insurance

Our goal is to help you obtain the periodontal and dental implant care you need. Our front desk has years of experience helping maximize insurance benefits and financing options so you can get the care that you need.

Account Statements:

We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Please call our office if your statement does not reflect your insurance payment within that time frame. Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.

Payment Methods

For your convenience we accept Discover, MasterCard, VISA and American Express.

CareCredit

We offer interest-free financing through CareCredit. Please ask our treatment coordinators if you are interested in more information about CareCredit financing options, or click here to visit the CareCredit website.

Insurance

As a courtesy, we will file your insurance claims for you, ultimately however your insurance coverage is a contract between you and your insurance carrier. Your portion of payment is due when services are rendered.

Our insurance coordinators deal with many different insurance companies. Some companies offer many different dental and medical plans. Some companies combine dental and medical coverage. This insurance alphabet soup changes policies and guidelines weekly. At times, it is almost impossible to accurately estimate our patients' insurance co-payment.

Many insurance companies will not give out fees until after the treatment is completed. Dealing with these companies can be difficult and time consuming. As a courtesy, we ask that you keep us informed of any change to your insurance. It is important that all information about you and your insurance be current. 

Below are some common facts and myths about dental insurance

FACT 1 – DENTAL INSURANCE PLANS ARE DESIGNED EXTREMELY DIFFERENTLY THAN MEDICAL INSURANCE PLANS

Dental insurance benefits differ greatly from traditional medical health-insurance benefits and can vary quite a bit from plan to plan. Where medical insurance was designed with the intent of covering the majority of costs, dental insurance was designed as a supplemental aid to the individual's costs. When dental insurance plans first appeared in the early 1970's, most plans had a yearly maximum of $1000-1500. Today, most plans still have an annual maximum of $1000-1500 with virtually no adjustment for inflation. Over the past 40 years premiums charged by insurance have certainly increased yet the benefits have not increased. Therefore, dental insurance is never a pay-all. Instead we must think of it as a great aid only. 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.

FACT 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
Dental insurance is a contract between your employer and a dental insurance company. The benefits you receive are based on the terms of the contract that was negotiated between your employer and the dental insurance company.  Our office has nothing to do with this relationship.

FACT 3 – INSURANCE CLASSIFICATIONS OF “UCR” ARE INACCURATE
You may have noticed that at times, your dental insurer reimburses you or the dentist 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. What exactly does this mean? A statement such as this gives the impression that any fee greater that 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.

A more accurate term is “Insurance allowable fee” as it is more accurate and not as misleading as the term “Usual, Customary, or Reasonable – UCR – is.

Insurance companies set their own schedules and each company uses a different set of fees they consider to be the "UCR/allowable” for the area.  In most cases, the “allowable” fees are set about 30% below actual industry standard for the local area so that the insurance company can make the profit they need in order to operate.  In general, the less expensive insurance policies will use a lower usual, customary, or reasonable (UCR) figure.

FACT 4 - DEDUCTIBLES & CO-PAYMENTS
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for a service is $150.00.  Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid.  First a deductible (paid by you), on average $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 (deductable ($50) + remaining balance ($20) = $70 to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 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.




If you have payment or insurance problems or questions, please ask our staff at 970-207-4061, by email at office@parisandshumakerperio.com, or by fax at 970-207-0051.