We want to help each patient maximize their insurance benefits! We accomplish this by submitting claim forms with the correct coding and any supporting documentation that is appropriate including narrative reports, copies of x-rays, and photos.
Dental insurance is diverse. Some policies cover only a small percentage of fees, while others cover 50% or greater. The more you or your employer pays for premiums, the better the coverage, in most cases. Many plans tell their insured that they will be covered “up to 80% or even 100%” but do not clearly specify plan fee schedule allowance, annual maximum, or plan limitations. Insurance is an aid, not a PAY-ALL.
Your benefits are probably based on “usual, customary, and reasonable” (UCR) fees. What does UCR mean? Great question! It is an artificial number that insurance companies created to minimize what they pay out. If you ask your insurance company for supporting documentation of their UCR fees, you most likely won’t get an answer. The fees considered reasonable and customary by your insurance provider probably do not reflect the type of care and service we consider standard.
What is LEAT? It is an insurance company term for Least Expensive Alternate Treatment. It is another tool insurance companies use to avoid payment for certain procedures. It may be written in your contract. You may be a victim of LEAT. An example would be: Denial of a fixed bridge or implant but reimbursement for an alternate procedure such as a removable partial or denture. Those are far from being the same procedures. The insurance company executive would not settle for LEAT.
Most dental insurances also carry a “missing tooth clause.” The clause states that your insurance will not pay for replacement of a tooth or teeth that were missing before your policy began.
Understanding how insurance works can be confusing and frustrating. We are here to help so please don’t hesitate asking us if you have any questions about your insurance policy.