Insurance Q & A
This section of our website provides information about dental insurance benefits.
We want you to understand how dental insurance works and how to make it work best for you. You should also understand how the treatment your endodontist provides works with your dental plan. The contract your employer negotiated with your insurance carrier defines your dental benefits. Please read the benefit of insurance plan booklet provided by your employer so that you better understand your benefits. Various dental plans cover Endodontic procedures at different payment levels and, as a result, your payment portion may vary. If you do not find the answers to your questions, contact your employers plan or benefits administrator who can explain the details.
Our experience with dental insurance contracts show us that misunderstandings most often occur concerning co-payments, usual and customary fees and in network and out of network providers.
Frequently Asked Dental Insurance Questions:
- What is a UCR and how is it determined?
- Why was my benefit different from what I expected?
- Why isn’t the recommended treatment a covered benefit?
- How do I know what my payment portion will be if my insurance does not cover the entire fee?
- How do I understand my Explanation of Benefits (EOB)?
- How long does it take for a claim to be paid?
- Will my Endodontist take my insurance?
What is a UCR and how is it determined?
UCR is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the maximum benefits available from your dental insurance.
- Your insurance plan paid only a percentage of the fee charged by your endodontist.
- The treatment you needed was not a covered benefit.
- You have not yet met your deductible.
- You have not reached the end of your plans waiting period and are currently ineligible for coverage.
Why isn’t the recommended treatment a covered benefit?
Your endodontist diagnoses and provides treatment based on his or her professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
How do I know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance check has been received by your endodontist.
How do I understand my Explanation of Benefits (EOB)?
Your Explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are not covered by your plan. The statement includes the following information: UCR, co-payment, amount/patient portion, remaining benefits, deductible and benefit paid.
How long does it take for a claim to be paid?
The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.
Will my endodontist take my insurance?
The Endodontic Specialists have signed contracts with several dental insurance carriers and agrees to accept the payment offered by the insurance company, even though it may not be the same amount as The Endodontic Specialists charge for the procedure. This means we are Participating Providers in those plans.
Our reception staff can inform you of the plans we participate with. If we participate with your dental plan, you will be required to pay the estimated co-payment, your deductible if it has not been met, and any amount over your annual maximum at the time of treatment.
There are some dental insurance plans that we do not sign contracts with, but we will still confirm your current status and benefits with your insurance company and submit your claim forms for you. Please contact the office you will be seen at and we will be happy to go over this information with you.
Our reception staff will inform you if we do not participate with your plan.
Our staff will make every effort to verify your insurance benefits before your appointment.
The amount the insurance company states they will pay is only an estimate that has been obtained over the telephone or on the web. Telephone/web verification does not guarantee payment from your insurance company. If we are unable to verify your insurance benefit, you will be responsible to pay the full amount or make payment arrangements in full at the time treatment is rendered. We will continue to try and confirm your benefits and submit necessary claim forms for you.
What if I still have questions?
Our reception staff will do their best to answer all of your insurance questions. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss the matter with your plan administrator and explore appropriate alternatives
Patients without dental insurance
Because of the nature of referral work and the high cost of extending credit, we must respectfully request that all patient balances be paid in full or arrangements for payment in full at the time of the actual treatment. If you are unable to pay for treatment upon completion, please advise us right away. We realize that this can be a problem for some of our patients. If you need an extended period of time to make payments, we will be glad to accept Visa, Mastercard, Discover, American Express and CareCredit.
CareCredit is a credit line for health care expenses. It allows you to start treatment immediately and pay over time with low minimum monthly payments. If you have a question about CareCredit, please contact any of our offices and our receptionist can help or contact CareCredit directly at 1 (800) 365-8295.