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INSURANCE: What you need to know


Our Philosophy:

 The primary concern of our staff is your dental health and we make recommendations accordingly.  It is the patient's responsibility to determine if - and when - any recommended care is covered by your insurance plan.  Once you have that information, you can make a prudent decision on how to proceed.  We hope that this guide will assist in answering any of your questions.
 
Claims:
 
The length of time it takes your insurance company to pay a claim depends on what steps the company requires you and Amarillo Family Dentistry to complete.  Each carrier has its own method of processing claims.  Amarillo Family Dentistry does file claims for you as a courtesy with the assignment of benefits, however, patients are ultimately responsible for the timely payment of those claims.  Amarillo Family Dentistry does try to assist you in getting your claim paid as quickly as possible.
 
Deductible:
 
A deductible is the set amount you must pay before your insurance coverage begins.  Commonly, most insurances have deductibles between $50.00 and $100 and a majority of insurance companies waive that deductible for preventative services so that it only applies to basic/major dental services.
 
Maxium Coverage:
 
This is the total amount of money your dental plan will pay during a benefit year.  Not all companies begin your benefit year in January.  Some insurance companies also have a lifetime maximum set for specific services.  It is recommended that you make yourself aware of your benefit year guidelines and maximums.
 
Dual Coverage:
 
This means you have coverage from more than one dental plan.  For example, you may be covered by your spouse's plan as well as your own.  Do not assume that the secondary plan will automatically pay any difference not covered by the primary plan.  Each company has it's own rules and guidelines and most insurance plans will not cover each others deductible amounts.  It is recommened to chech with both policies to determine their guidelines and limits of coverags.
 
Co-Payments:
 
Simply stated, a co-payment is your portion of the fee charged, usually a percentage.  For example, your insurance company pays 80% of the bill, while you are responsible for the remaining 20% and any service that was not covered.
 
100% Coverage Vs. 100% Payment:
 
When your policy says it covers 100% of "usual, customary and reasonable (UCR) fees, that means it pays the amount the insurance company has calculated that a procedure or service costs based on their market surveys.  Each insurance company will determine, generally, a different amount for the sam procedure.  For example, Insurance company A will determine that a cleaning should be $60.00 an Insurance company B will determine that it should be $48.00, then the two companies will pay 100% ot THEIR calculations.  Therefore, 100% does not mean that your insurance will necessarily cover the entire cost that the provider charges.  Patients are responsible for any expenses not covered by their insurance company abover what that company determines is the UCR.  The exception to this it if the dental provider you use has a "contract" with your particular insurance company.
 
In-Network Vs. Out-of-Network:
 
If a dental office is "in" network with your insurance company, this simply means they have a contract agreement with that insurance to only charge what the company has determined to be the fee for any given procedure that they cover.  The insurance company will then pay the appropriate percentage of that set fee.  If a dental office is "out" of ntwork with your insurance company, they do not have a contract with that insurance and you are responsible for the difference between what the insurance pays and what the office charges.
 
Determining What You Owe:
 
If 100% coverage does not equal 100% payment, you are probably wondering, "How much will I owe?"  Amarillo Family Dentistry's experience working with dental insurance companies allows us to provde you with a reasonable estimate of what your plan is likely to pay.  Unfortunately, because of such things as maxiums, deductibles, non comvered procedures, ect., calculating the exact coverage is impossible.  We advise that you check your policy carefully or call your insurance company.
 
 
Insurance can be a complicated issue, especially when you consider the range of dental plans that Amarillo Family Dentistry works with for our patients.  Unfortunately, we cannot know what procedures are covered or not covered by individual patient's insurance plan.  Therefore, we rely on you to be familiare with your coverage.
 
Amarillo Family Dentistry will try to always explain treatment and the fees for that treatment.  If you have insurance, we will try to estimate the amount of your benefit based on our experience with your insurance company.  You will be required to pay any amount that we estimate to be your portion on the day of your appointment for that procedure.