Our office participates directly with Delta Dental Premier and Cigna PPO. For all others, there is no direct relationship between Children’s Dentistry of Morristown and your insurance company. We will be more than happy to provide you with a walkout statement which you can submit to your insurance carrier directly. For those that do participate with Delta Dental Premier and Cigna, please bring your insurance card with you to the appointment. If you do not have a card, you can go directly to their website and print one out.
Also, it is helpful to be knowledgeable about your insurance benefits with regard to eligibility for hygiene visits (ie. every six months versus twice a year). This may impact the scheduling of your child’s appointments.
We understand that the complexities of insurance contracts are very confusing. However, no dental insurance pays 100% of all procedures. Most dental plans will cover only 50% – 80% of the total average fees. There are many different dental plans and the amount of coverage is based on the contract that is set up by the insurance company and this contract is determined by your employer. The less that is paid for insurance by the employer, the less coverage you will often receive.
Our office does not determine your benefits. This contract relationship is between you and the insurance company with the benefits determined, as mentioned above, by the contract your employer offers. The insurance company will often state that the dentist’s fee has exceeded the usual, customary or reasonable fee (UCR). This gives the impression that any fee greater than amount covered or paid by the insurance company is unreasonable. This is simply not accurate and very misleading. The insurance company arbitrarily chooses a level which they call “allowable UCR”. These fees are determined by the insurance company in order for them to make a net profit. Unfortunately the insurance companies imply that the dentist is “overcharging” rather than stating that they are “underpaying”.
We will fully attempt to help you receive the full insurance benefits. However, ultimately, you are personally responsible for your account.