1.) Your insurance is a contract between you, your employer and the insurance company. We are not party to this contract. As such, the ultimate decision regarding coverage and/or the amount of benefits allowable under your policy rests with your insurer and is not within our control.
2.) Our fees are generally considered to fall within the acceptable range by most insurance companies and therefore, are covered up to the maximum allowable determined by each carrier. This applies only to insurance companies who pay a percentage of “UCR”. UCR is defined as usual, customary, and reasonable fees for this region. Thus, our fees are considered usual, customary, and reasonable by most companies.
3.) Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover.
We must emphasize that as dental care providers, our relationship is with you, not your insurance company. Your insurance policy is a contract between you and your insurance company. It is important that you understand it’s provisions. We cannot guarantee payment of your claims. Regardless of what we might calculate as your benefit in dollars, we must stress the fact that you are responsible for the total cost of your dental care. Reduction or rejection of your claim does not relieve the financial obligation you have incurred.
In the event you do not receive the benefits which you believe you have purchased from your insurance carrier, contact your employer’s benefit department, your insurance representative, or the state insurance department. Since the dentist is not the owner of the policy, these agencies refuse to resolve problems when petitioned by the doctor. However, as always, we will be glad to assist you in any way we can to assure you of maximum benefits.