Frequently asked dental insurance questions

What is a "UCR" and how is it determined?

  • "UCR" is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.

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Why was my benefit different from what I expected?

Your dental benefit may vary for a number of reasons, such as:

  • You have already used some or all of the benefits available from our dental insurance.
  • Your insurance plan paid only a percentage of the fee charged by your endodontist.
  • The treatment you needed was not a covered benefit.
  • You have not yet met your deductible.
  • You have not reached the end of your plan's waiting period and are currently ineligible for coverage

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Why isn't the recommended treatment a covered benefit?

  • Your endodontist diagnoses and provides treatment based on his or her professional judgement and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary root canal procedures as a way to reduce their costs. Your plan my not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.

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How do I know what my payment portion will be if my insurance does not cover the entire fee?

  • Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until payment has been received by your endodontist.

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How do I understand my explanation of Benefits (EOB)?

  • Your explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan. The statement includes the following information: UCR, copayment amount/patient portion, remaining benefits, deductible and benefit paid.

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How long does it take for a claim to be paid?

  • The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.

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Will my endodontist take my insurance?

Participating Provider

Orland Endodontics has signed contracts with several dental insurance carriers and agree to accept the payment offered by the insurance company, even though it may not be the same amount as Orland Endodontics charges for the procedure. This means we are Participating Providers in those plans.

Our reception staff can inform you of the plans we participate with. If we participate with your dental plan, you will be required to pay the estimated co-payment and your deductible if it has not been met, at the time of treatment.

Non-Participating

There are some dental insurance plans that we do not sign contracts with but will still submit the claims and take insurance company payments as partial payment. In this instance, you will be responsible for a payment portion over and above the percentage provided by your insurance company.

Our reception staff will inform you if we do not participate with your plan.

If we do not participate with your dental plan, we will still confirm your current status and benefits with your insurance company and submit your claim forms for you. You will only be required to pay the amount that is not covered by your insurance company.

Insurance Verification

Our staff will make every effort to verify your insurance benefit before your appointment.

The amount the insurance company states they will pay, is only an estimate that has been obtained over the telephone. Telephone verification does not guarantee payment from your insurance company. If we are unable to verify your insurance benefit you will be responsible to pay the full amount at the time treatment is rendered. We will continue to try and confirm your benefits and submit necessary claim forms for you.

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Insurance Pre-Authorization

If you would prefer, and don't need immediate treatment, we can request a pre-authorization for treatment from your dental insurance company to find out the exact reimbursement for the procedure necessary. This may take approximately 2 weeks.

After receiving the pre-authorization from your insurance company we would then contact you to set up your treatment appointment.

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What if I still have questions?

Our reception staff will do their best to answer all of your insurance questions. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss the matter with your plan administrator and explore appropriate alternatives.

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