Memorial Dentists will file dental insurance claims as a courtesy to our patients. We do not have a contract with each insurance company, only the patient does. Memorial Dentists is not responsible for how an insurance company handles claims or for what benefits they pay on a claim. We can only assist in estimating the portion of the cost due for the services we provide. Memorial Dentists, at no time, guarantees what insurance will or will not do with each claim. Ultimately, Memorial Dentists is not responsible for any errors in filing dental insurance, but will make every effort to help our patients through this process. Once again, Memorial Dentists file claims as a courtesy to our patients.
Memorial Dentists accepts most dental insurance plans. We are participating providers with most insurance plans. Memorial Dentists also participates with Cigna DMO and Delta Care USA DMO plans.
What to Expect from Your Dental Insurance
Interview with Dr. Terri Alani:
There are several types of plans; here is an explanation of different types:
UCR – Usual, Customary and Reasonable fees
Insurance companies establish UCR fees, as explained below:
- A “usual” fee is the fee that an individual dentist most frequently charges for a specific dental procedure.
- A “customary” fee is the fee level determined by the administrator of a dental benefit plan from actual fees submitted for a specific dental procedure. This fee establishes the maximum benefit payable for that procedure.
- A “reasonable” fee is the fee charged by a dentist for a specific dental procedure that has been modified by complications or unusual circumstances.
Therefore, it may differ from the dentist’s usual fee or the benefit administrator’s customary fee.
The concept of using UCR fees to determine how much to reimburse patients covered by dental insurance for specific treatment was introduced by the insurance industry in the early 1960s.
PREFERRED – Preferred Provider Organization
A Dental PPO will allow for both “in-network” services as well as “out-of-network” services. In-network services are usually covered at a higher level with less subscriber out-of-pocket costs, while out-of-network services are covered at lower levels and can require the subscriber to bear a greater portion of the cost.
DHMO – Dental Health Maintenance Organization
Under a Dental Maintenance Organization (DMO), services are available on an “in-network” basis only. Payment for services are usually in the form of a copay. These copays are usually higher because they make up the majority of the cost of the service. No coverage is offered for services provided by dentists outside of the DMO network.
Discount plans are simply a plan where the patient pays a copay determined by the plan. These plan benefits are available on an “in-network” basis only. These plans are quite similar to a DMO however there is no co-insurance payment from the plan.