At Uno Dental, we’re here to help. Whatever your insurance coverage or status, we can make sure your dental care is customized, affordable, and comfortable.
Almost all dental plans are a contract between your employer and an insurance company. Your employer and the insurer agree on the amount your plan pays and what procedures are covered.
Often, you may have a dental care need that is not covered by your plan. Employers generally choose to cover some, but not all, of employees’ dental costs. If you are not satisfied with the coverage provided by your insurance, let your employer know.
At Uno Dental, we’re here to help you have a healthy, functional smile. In order to make sure we can provide quality care to everyone, we are out-of-network for all insurance providers. What this means is if you have a PPO plan, you have the freedom to choose your provider. Dental insurance can be very difficult to understand, therefore our billing team is here to help you file your insurance claim as a courtesy service. Sometimes, specific procedures are not covered by your plan (or are only partially covered). In this case, you’re responsible for paying the rest of the costs to your dentist. Sometimes, specific procedures are not covered by your plan (or are only partially covered). In this case, you’re responsible for paying the rest of the costs to your dentist.
Many insurance providers may use one of the following factors or all as tools to aid in further cost-control over what dental plan pays, these tools are instruments to curb any reimbursements to the minimum amount. At UNO Dental we have outlined some of these practices to help understand why sometimes plans cover less than estimated:
Using outdated or inappropriate UCR Fee Schedule
When looking at your dental coverage, you might come across the term “UCR Charges/Fee Schedule”, or Usual, Customary, and Reasonable charges. UCR charges are the maximum amount covered by your plan. Although these terms make it sound like a UCR charge is the standard rate for dental care, it is not. The terms “usual,” “customary,” and “reasonable” are misleading for several reasons:
- Insurance providers can set whatever amount they want, which may or may not be based on average dental costs for your area.
- A company’s UCR fee schedule may stay the same for many years, and your insurance company isn’t required to adjust these figures for inflation and rapidly increasing costs of dental care.
- Insurance providers can have unique formulas to determine their UCR fee schedules and are not required to disclose it to dental offices.
As such, we cannot guarantee any specific amount for reimbursement from your insurance provider. Additionally, a high dental bill does not mean your dental provider charged too much – it simply may mean your insurance provider’s UCR is not updated, as well as your provider is using a fee schedule taken from areas of different states, or different areas from your state. In order to get the most accurate idea of reimbursement, it is important to request your insurance company’s fee schedule to compare with UCR fees.
For example, if your insurance quotes you 100% coverage however they only accept $15 on their fee schedule for an UCR fee of $30, this will leave you with a $15 out-of-pocket fee.
Most Annual Maximums for each dental plan haven’t seen an update since 1970s
Many dental plans may offer $1000 on average toward a plan’s annual maximum amount per patient. An annual maximum is the largest amount that a plan will pay throughout the year. These amounts have not seen a raise since 1970s according to historical data. Your employer determines the amount of annual maximum in their contract with your insurance provider. Employers tend to choose the lowest amounts possible as a cost-cutting measure to curve spending on employees’ benefits.
Furthermore, insurance providers keep those figures in place to avoid paying any amount beyond the annual maximum amount. Unlike medical insurance, which covers all your expenses once your deductible is met. Dental plans only pay for the annual maximum a year, and once met the patient is then held responsible for further amounts. Hence why we believe it’s misleading of dental plans’ providers to refer to their plans like dental insurance when it acts as a coupon rather than traditional insurance (i.e., medical, auto, home insurance).
Misleading Myths of Insurance Preferred Providers (PPO Plans)
A preferred provider is a dentist contracted with your insurance company – your insurance company then includes them in a list of providers they prefer you receive treatment from. Unfortunately, such preferred providers may find themselves in a position where they must jeopardize the quality and standard of care in various procedures by either trying to increase the capacity and volume of patients seen per day or utilizing sub-par quality of dental materials in order to offset for the low fee schedule paid to these providers in order to be listed on the dental insurance preferred provider network.
At UNO Dental, we believe in customized dental care, personalized to each patient by providing them with ample time with their dentist. We utilize the best dental materials in the market, top-notch technology, and never use any materials that may be harmful, toxic, or controversial dental materials jeopardizing our quality and standard of care. The good news is that most PPO plans have the freedom option to choose outside of these lists. Patients that value customized care with great attention and the latest technology will find UNO Dental as their premier partner during their dental journey.
Many dental plans have extensive fine prints, exclusion clauses, and complex stipulations to understand and unravel. Combined it serves as cost-cutting measures to curb reimbursements, we have compiled a few examples as follows:
- Pre-Existing Conditions
- If you have a condition before enrolling in a dental plan, it may not be covered. For example, replacing a missing tooth may not be covered if you lost it prior to enrollment. However, oral care going forward is generally covered by your plan.
- Coordination of Benefits (COB)
- Some patients are covered under more than one dental plan. However, even if you have two or more plans, you may still be responsible for some costs. Make sure to check with your providers for specific details about your coverage.
- Plan Frequency Limitations
- Your plan may only provide coverage for the same treatment a limited number of times. These limitations are set without any scientific basis and most importantly are not based on patient needs, rather what your employer and the dental plan provider have agreed to pay. For example, you may need teeth cleaning 3 or more times per year, but your plan only covers 2. It’s important to prioritize your dental health, and work with our team can help you navigate your cost and financing options.
- Medically/Dentally Unnecessary
- Many dental plans may state that only procedures that are medically or dentally necessary will be covered. Another misleading factor used to further curb claims’ reimbursement amount or even deny coverage. If a claim is denied, it does not mean that the services were not necessary. Additionally, dental plans may use their own dental recommendations and dictate the type of care you’d be allowed to have. The profession of dentistry is impossible to conduct remotely, and many plans may dictate what dental treatment in order to pick the least-cost incurring treatment. At UNO Dental, we are out of network with dental plans solely for this reason as we believe treatment decisions must be made by you and your dentist. Your dentist can give you the best recommendation of what’s necessary for your health and our team can help you fit the best treatment within your budget.
Final Thoughts, Make Your Dental Health the Top Priority
Dental insurance can be confusing and has many different factors but it’s necessary to remember that dental insurance acts as a coupon and is only one part of your healthy mouth plan. We understand It can be tempting to decide on treatment based on your costs after insurance, but your oral health is the most important to your health and only you can make that your top priority. If you find out what your dental plan covers and plan accordingly, it can help you have a healthy mouth. Work with your dentist to take the best possible care of your teeth so they will last a lifetime! For any further questions you may have for our team or would like to schedule an appointment, you can do so online or by contacting us.
We collect in full at the time of service. Then, your claim will be submitted on your behalf as a courtesy. You can generally expect a reimbursement check to arrive in the mail within 30-45 days depending on your insurance provider processing times. Please note that we have no control over how fast claims are processed for reimbursements. Each insurance plan is different, and many of them are citing COVID-19 related delays that are outside of our control.