Embedded Pediatric Plans Linked to Your Medical Insurance 
Recently there is a requirement for all small and large group plans as well as plans on the Affordable Healthcare Exchange to include embedded pediatric dental plans in their medical insurance. There are pro’s and con’s to this coverage. The plans usually cover preventative treatments at a high rate. However, since they are linked to your medical deductible larger, more expensive, procedures could be 100% out of pocket until your medical deductible is met. We will do our best estimate what your out of pocket expense will be but we highly recommend calling your medical insurance company to verify your benefits as well.

No Private Insurance Pays 100% of All Procedures
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This unfortunately is not true. Most plans only pay between 50%-80% of the average total fee. The percentage paid is dictated by your insurance company. Treatment plans will estimate your out of pocket expense and the benefits that your insurance company typically apply.

Benefits Are Not Determined By Our Office
Every insurance plan has a contracted fee schedule that dictates how much the clinic can be reimbursed for all procedures. This varies greatly from insurance to insurance and plan to plan. If you have insurance the clinic does not decide how much you will pay for services, your insurance does. We can provide an estimate based on what your insurance will cover and the fees they decide the patient will pay and the clinic will receive.

Deductibles & Co-Payments Must Be Considered
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.