Westpark Helpful Dental Articles

Molly MacBride, Insurance Coordinator, Explains Benefits

As the Insurance Coordinator here at West Park Dental, I know that the most common misperception about dental insurance is that it is like medical insurance. In fact, dental insurance is not really insurance in the traditional sense but more of a benefit plan that helps our patients supplement their out-of-pocket expenses. The result is that just because the doctor deems a treatment to be necessary does not mean that the dental insurance company will agree to pay the benefits.

Another misconception is that dental insurance will cover 100% of dental fees for many procedures. The usual and customary rate (UCR) is the cost the insurance company has agreed to pay for a certain procedure, but this is not necessarily 100% of the costs that are incurred for the work. The UCR is often based on zip codes, so insurance companies are creating their reimbursement schedules based on geographic zones rather than on the fees actually charged.

At West Park Dental we assign benefits and have the difference charged to our practice. If a patient is in-network and there is a difference in the amount the insurance company will pay and our fee, we absorb that difference so the patient need not pay more than the insurance company allows. As a courtesy to our patients we write-off that difference in cost.

The good news is that the patient will have a portion of their costs paid for by the insurance company. Part of my job is to help the patients maximize their benefits, helping them understand the explanation of benefits (EOB) they get in the mail from the insurance company. With all the rules and regulations that come with dentistry and insurance coverage I find it very rewarding to help patients understand how to maximize the benefits.

Molly MacBride, Insurance Coordinator
West Park Dental
Cleveland, OH

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Posted 04/27/2020

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