Insurance
Insurance can be a complicated issue, especially when you
consider the range of dental plans which cover Valley Dental
Group patients.
Unfortunately, VDG cannot know which procedures are or are not covered by
each patient's plan. Therefore, we rely on you to be familiar with your own
coverage.
Our Philosophy
When
our staff provides care, our primary concern 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 an insurance plan.
Once you have that information, you can make a careful decision
on how to proceed. We offer the following guide to understanding
dental insurance.
Claims
The length of time it takes your insurance company to pay a claim depends on
what steps the company requires you and VDG to complete. Each carrier has
its own method of processing claims. Ultimately, patients are responsible for
their claims. However, working as a team, VDG can help you get your claim
paid as quickly as possible.
Deductible
A deductible is the set amount you must pay before your insurance coverage
begins.
Maximum Coverage
This is the amount of money your dental benefit plan will pay over a period of
time. Most companies set a yearly and lifetime maximum. And, not all
companies begin their benefit year in January. We recommend that you check
your policy.
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. Don't assume
that the second plan will automatically pay any difference not covered by the
first. Each company has its own rules. Check both policies carefully.
Co-Payments
Quite simply, a co-payment is your portion of the fee, usually a percentage. For
example, your insurance company pays 80 percent of the final bill, while you are
responsible for the remaining 20 percent. Let's say the charge is $100. Your
portion would equal $20, right? Well, maybe. Read on...
100% Coverage vs. 100% Payment
When your policy says it covers 100% of "usual, customary and reasonable -
(UCR)" fees, it means it pays the amount the insurance company has calculated
that a procedure or service costs based on market surveys. It doesn't mean that
it covers 100% of what a dental provider actually charges. Ultimately patients
are responsible for any expenses not covered by their insurance plan.
Determining What You Owe
If 100 percent coverage doesn't equal 100 percent payment, you're probably
wondering, "How much will I owe?" VDG's experience working with dental
insurance companies allows us to provide you with a reasonable estimate of
what your plan is likely to pay. Unfortunately, because of such things as
maximums, deductibles, etc., calculating the exact coverage is impossible. We
advise you to check your policy carefully or call your insurance company.
Please verify your insurance coverage with the VDG receptionist at each visit. If you've
changed employers or insurance coverage, it is critical that VDG change your records to
insure that the claim is sent to the correct insurance office to avoid payment delays which
could result in finance charges to you.
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