Q: What is a “UCR” and how is it determined?
A: “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.
Q: Do most dental insurance policies provide the same coverage for root canal treatment whether performed by an endodontist or a general dentist?
A: Most dental insurance policies provide the same coverage for root canal procedures whether they are performed by an endodontist or a general dentist. Endodontists do not determine their fees in cooperation with insurance companies. Because of this, the endodontist’s fee and the insurance plan’s benefit may not always match. The insurance contract is between the patient and the insurance company. Therefore, we have no control over what a policy will pay. A pre-determination of benefits can be filed if you need to know the specific benefits and limitations of your policy concerning a specific procedure.
Q: Do most dental insurance policies cover retreatment? Within one year of the original procedure? After one year or more? When treatment was performed by a general dentist? By another endodontist?
A: While dental insurance may cover part or all of the cost for retreatment, some policies limit coverage to a single procedure on a tooth in a given period of time. Check with insurance company prior to treatment to be sure of your out of pocket expense.
Q: What if I am out of town and need emergency treatment – will my policy cover it?
A: It depends on your insurance. Usually, your health coverage goes with you when you travel. No matter what plan you have, you’re covered for emergency care, across the country or around the world. Be sure to check with your insurance first.
Q: Should I take any insurance forms with me to the endodontist?
A: You should receive an email from our office with the online insurance forms for you to complete. If you have not received this email, please email us at email@example.com.
Q: Why was my benefit different from what I expected?
A: Your dental benefit may vary for a number of reasons, such as:
-You have already used some or all of the benefits available from your 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.
Q: Why isn’t the recommended treatment a covered benefit?
A: Your endodontist diagnoses and provides treatment based on his or her professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
Q: How do I know what my payment portion will be if my insurance does not cover the entire fee?
A: 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 the insurance check has been received by your endodontist.
Q: How do I understand my Explanation of Benefits (EOB)?
A: 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.
Q: How long does it take for a claim to be paid?
A: 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.
Q: What is the best source of information about my own insurance coverage?
A: Call your insurance company.
Q: What should I do if I have questions about treatment I’ve received?
A: Call us at (303) 893-3636