We want to help each patient maximize their dental insurance benefits! We will help by supplying claim forms with the correct coding and any supporting documentation that is appropriate including narrative reports, copies of x-rays, and photos.
While we understand that getting your money back from the dental insurance company is important, we never lose sight of our first priority - your dental health. Therefore, we do not allow insurance companies to dictate the quality of care to us. Patients and the doctor decide what is best together, and then we proceed with the patient's goals in mind.
Dental insurance is diverse. Some policies cover only a small percentage of fees, while others cover 50% or greater. The more you or your employer pays for premiums, the better the coverage, in most cases. Many plans tell their insured that they will be covered "up to 80% or even 100%" but do not clearly specify plan fee schedule allowance, annual maximum, or plan limitations. Insurance is an aid, not a PAY-ALL.
Your benefits are probably based on "usual, customary, and reasonable" (UCR) fees. What does UCR mean? Great question! It is an artificial number that insurance companies created to minimize what they pay out. If you ask your insurance company for supporting documentation of their UCR fees, you most likely won't get an answer. The fees considered reasonable and customary by your insurance provider probably do not reflect the type of care and service we consider standard. We are not a clinic, and we offer many luxuries and technologies to make your dental care experience comfortable. We invest time with each of our patients. To us, you are a person, not a number or a chart. Our dentists and our team invest in more continuing education than is required so that we can bring you the best dental care possible.
What is LEAT? It is an insurance company term for Least Expensive Alternate Treatment. It is another tool insurance companies use to avoid payment for certain procedures. It may be written in your contract. You may be a victim of LEAT. An example would be: Denial of a fixed bridge or implant but reimbursement for an alternate procedure such as a removable partial or denture. Those are far from being the same procedures. The insurance company executive would not settle for LEAT.
Most dental insurances also carry a "missing tooth clause." The clause states that your insurance will not pay for replacement of a tooth or teeth that were missing before your policy began. Our third party financing companies can help you afford dental implants, partials, dentures, or bridgework.
Insurance carries do NOT cover many routine dental services. Please do not hesitate to ask us any questions about our dental office policies. We want you to be comfortable in dealing with these matters, and we urge you to consult us if you have any questions regarding our services or your dental insurance in North Dallas. It is also a good idea to communicate with your company's human resource department or president and ask for assistance with your insurance benefit and/or appeal.
