UNDERSTANDING DENTAL INSURANCE

SUBMITTING CLAIMS

If you provide us with your dental insurance information prior to treatment, we are happy to file your dental insurance claims on your behalf.  We can file claims with all private dental insurance providers even if we are not "in-network."  


We encourage you to be familiar with your insurance benefits, as we will collect your estimated "out-of-pocket" portion at the time of your procedure. We are happy to assist you in estimating your portion for the cost of treatment.  If your insurance pays more than the estimated amount, we will reimburse you the difference.

DELTA DENTAL

Restoration Dental Center is a preferred provider for Delta Dental.  This means that we are "in-network" for Delta Dental policies provided by your employer. 


This does not include plans offered by the state of lowa that are serviced through Delta Dental. We cannot submit claims for Dental Wellness Plan or Hawki policies.

To find a Hawki Dentist, click here.

To find a DWP Dentist, click here 

FOR REFERENCE

  •  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%-100% of all dental fees. In reality, most only pay between 50%-80% on average.  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.

  •  BENEFITS ARE NOT DETERMINED BY OUR OFFICE

You may have noticed on your Explanation of Benefits (EOB) that 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 is misleading and inaccurate.

Insurance companies set their own reimbursement 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 the claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. The UCR fees are set by the insurance company so they maintain a net 20%-30% profit.

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 & CO-PAYMENTS MUST BE CONSIDERED

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 benefits will be paid. First a deductible (paid by you), on average $50, 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 a $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 than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.