Dr. Michael Wilhite and our knowledgeable dental team are happy to educate our patients about dental insurance in Davidson, North Carolina. Most dental plans are a contract between your employer and the insurance company. Your dental coverage is based on how much your employer pays into the plan. Our office will file dental insurance claims electronically to serve you. Our patients typically see their insurance reimbursement checks back from their insurance company in an average of 10 business days. Keep in mind that any amount that is not covered by your insurance is your responsibility. Please also read through our guide on in-network versus out-of-network dentistry.
Our team understands how confusing dental insurance can often be. The biggest misconception is that dental insurance will pay for all of your dental care. This is simply not true. Most contracts have come with yearly limits, limitations on treatment and/or varying degrees of “co-payments”.
It’s important to know that all levels of payment by insurance companies are governed by the premiums already paid. Additionally, they actually have nothing to do at all with the actual fee for the services that have been provided. Our fees are based on a combination of our costs, our time, and our consistent dedication to providing you with the highest level of quality dental care.
The treatment recommended by our practice is never based on what your insurance company will pay, as your oral health care should not be governed by your insurance company.
Usual, Customary and Reasonable (UCR) Charges
UCR charges are the maximum allowable amounts that will be covered by your plan. Insurance companies choose whatever amount they like for UCR charges. This amount may not match the current fees charged by dentists in the area. An insurance company may keep their UCR amounts the same for several years. They are not required to keep up with inflation or the costs of dental care. Insurance companies are not required to reveal how they set their UCR rates. Each dental insurance company has their own formula.
Here are a few insurance terms to know:
- Annual maximums are the largest dollar amount a dental plan will pay during the year.
- Preferred providers are dentists who have a contract with the dental benefit plan.
- Preexisting conditions are conditions that existed before you enrolled in the insurance plan. Your insurance may not cover these conditions.
- Coordination of benefits (COB) or nonduplication of benefits applies to patients who have more than one dental plan. The benefit payments from all insurers should not add up to more than the total charges.
- Plan frequency limitations means that a dental plan may limit the number of times that they will pay for a certain treatment.
- Not dentally necessary means that the dental plan can state that only procedures that are medically or dentally necessary will be covered.
Feel free to contact Davidson Cosmetic & Family Dentistry today at 704-987-2277 to learn more and schedule your next visit with our dentist.
In-Network vs. Out-of-Network Dentists