Dental Insurance

Cornerstone Dental is committed to providing its patients with the optimum level of dental care. In an effort to maintain a high quality of care, we would like to share some facts about dental insurance with you.

Our Office Policy Regarding Dental Insurance

If we have received all of your insurance information by the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance so your insurance company will receive each claim within the days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If the balance has not been paid within 60 days, accounts are turned over to Trojan collections. We will be glad to send a refund to you once insurance has paid us.

Please understand that we file dental insurance as a courtesy to our patients. 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 at no time guarantee what your insurance company will or will not do with each claim. Once again, we file claims as a courtesy to you. We accept the following insurances Metlife, Aetna PPO, Delta Dental and Empire BlueCross BlueShield. This does not mean that we take these insurances as payment in full, as this is completely up to the contract you have with you and your employer.

What You Need to Know About Dental Insurance

Insurance Payments for Dental Procedures

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% to 100% of all dental fees. This is not true! Most plans only pay between 50% to 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. There are literally thousands of contracts available for employers to choose from.

Determination of Benefits

Your dental insurance benefits are not determined at all by your dentist. Insurance companies set their own schedules 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 takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. Frequently this data can be three to five years old and the insurance company sets the "allowable" fees so they can make a net 20% to 30% profit. 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 has exceeded 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 not accurate.

Unfortunately, insurance companies imply that your dentist is "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

Deductibles and Co-Payments

When estimating dental benefits, deductibles and 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, we can figure out what benefit will be paid. First a deductible (paid by you), on average $50.00, 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 the $150.00 fee they will pay an estimated $80.00, leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less tan $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 any specific questions about your insurance plan, please contact your employer or your insurance company. Our staff will be happy to answer any general questions you might have.

What About Finances?

Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan that fits with your timetable and budget. We accept cash, personal checks, debit cards and most major credit cards. We also utilize a company which provides a 12 month interest free payment plan for your convenience.

Key Facts/Benefits

• FACT #1: Your dental insurance is based upon a contract made between your employer and an insurance company.
• FACT #2: Dental insurance benefits differ greatly from general health insurance benefits. Dental insurance is never a pay-all; it is only an aid.
• FACT #3: Any doctor in a high quality private practice will have fees that insurance companies define as higher than "usual and customary".
• FACT #4: Insurance companies do NOT cover many routine dental services.
• FACT #5: The amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer put in, less the profits of the insurance company.