The majority of our patients have dental insurance, and our team will help maximize the coverage you have. We will take care of filing your claims electronically along with any necessary information. Insurance coverage is variable based on the company and the plan.
People choose our office because of the world-class level of care that Dr. Linger and our team provide. There are very few dental offices in the world that can offer the highest level of doctor training, cutting-edge technology, and concierge-level care that provides all types of treatment in one location with one doctor.
We are focused 100% on taking care of our patients and not the insurance companies. We do not let insurance companies interfere with our Doctor-Patient relationship. For this reason, we are not bound by any insurance company contracts.
This approach designates us being "Out of Network." It means that we are free to provide you with any care that you need and your insurance company does not limit us.
For most plans, you can still use your dental insurance when going out of network. Unlike being out of network for medical insurance, where you get no coverage. You may have a small out-of-pocket expense more than an in-network provider.
For many of our patients, the difference in seeing us vs. an in-network provider is $5 or less for routine visits. Many insurance companies will reimburse you directly if you go out of network vs. sending the payment to the provider.
Most people have seen rapid decreases in the quality of dental plans in the last few years. The amount of care that dental insurance provides is far less than it was just a few years ago.
For this reason, many patients have opted to purchase dental insurance. We have also created a special in-house plan for our patients who do not have dental insurance.
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Fact 1 – No insurance pays 100% of all procedures
Dental insurance is meant to be an aid in receiving dental care. Many people think that their dental insurance pays 90% to 100% of all dental fees. This is not true! Most plans only pay approximately 50% to 80% of the average total fee. Some pay more, some pay less. The percentage is determined by how much you or your employer has paid for the coverage or the type of contract your employer has set up with the insurance company.
Fact 2 – Benefits are not determined by our office
You may have noticed that sometimes your dental insurer reimburses you 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 insurance 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 fee schedule and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from 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 3 to 5 years old and these “allowable” fees are set by the insurance company so they can make a net 30% profit or more.
Unfortunately, insurance companies imply that your dentist is “overcharging” rather than say that they are “underpaying” for procedures. In general, the less expensive insurance policy will use a lower usual, customary or reasonable (UCR) figure.
Fact 3 – Deductibles & Co-Payments must be considered
When understanding dental benefits, deductibles and co-payment percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, you can calculate the benefit that you will be reimbursed. First a deductible (if applicable), on average $50.00, will be subtracted, leaving a $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of the $100.00, or $80.00. Of course, if the UCR is less than $150.00 or your plan may be only paying 50%, then your insurance reimbursement will be significantly lower.
Most importantly, please keep our office informed of any insurance changes such as policy name, insurance company address, or a change of employment.
