Dental Insurance Chicago | Bucktown Dental Associates
Bucktown Dental Associates accepts most dental insurance plans. We will submit insurance claims for you. At Bucktown Dental Associates, we make it easy for you to pay copayments, deductibles, and fees for services not covered by dental insurance.
It is important to ask our business staff about dental treatment costs prior to agreeing to and receiving treatment. We will be happy to answer all your questions about dental insurance. Dr. Elseweifi is a provider for several dental PPO insurance plans. He is a network provider for Delta Dental, Blue Cross & Blue Shield of Illinois, Aetna, Cigna, Guardian, Humana, and Metlife.
Dental Insurance Explained:
The following information will help you understand some terms and practices common with dental insurance.
Your dental insurance plan is designed to share in your dental care costs. It may not cover the total cost of your bill. Most plans cover between 50% and 80% of dental services. Dental insurance plans differ in the level of reimbursement offered for certain procedures and in annual dental spending caps. Some plans limit the waiting period before certain dental treatments are rendered.
Usual, Customary, and Reasonable (UCR) Fees
The most common term used by dental insurance companies on their Explanation of Benefits (EOB) statement to identify the fee for dental treatment is called Usual, Customary and Reasonable (UCR). UCR fees are determined by insurance providers based on the typical costs associated with various dental procedures.
For example, if your procedure costs $90, your dental insurance provider may have a UCR for the procedure of $60. You would therefore be responsible for paying the $30 difference as an out-of-pocket expense.
Least Expensive Alternative Treatment Clause (LEAT)
Under a LEAT clause, when there are several treatment options available for a specific condition, the plan will only pay for the least expensive treatment alternative. Dr. Elseweifi will show you the options and recommend the best option for your care.
The most common example of LEAT clauses being administered are when composite fillings are alternate benefited to amalgams and when crowns are alternate benefited to large fillings.
The following is an example of how the alternate benefit would be paid under some dental benefit plans:
- You receive posterior resin-based composite restoration.
- Dental plan covers only amalgam restorations for posterior teeth and has an alternate benefit provision.
- Dental plan pays 80 percent of the allowable fee ($60) for amalgam which is $48; you pay a $12 copayment.
- You pay the difference between the allowable fee ($90) for composite and the $60 fee for amalgam, which is $30.
- Your total =$42; Plan total =$48.
At Bucktown Dental Associates, we make it easy for you to pay any copayments, deductibles, and fees for services not covered by dental insurance. You can use CareCredit to pay for such fees. You can begin your treatment immediately - then pay for it over time with monthly payments that fit easily into your monthly budget.
Your dental insurance may not cover conditions that existed before you enrolled in the plan, such as missing teeth. Even though your plan may not cover certain conditions, treatment may still be necessary.
Your dental insurance plan may not cover certain procedures, or preventative treatments such as sealants. This does not mean these treatments are unnecessary.
Your dental insurance plan purchaser makes the final decisions on "maximum levels" of reimbursement through the contract with the insurance company.
Even though the cost of dental care has significantly increased over the years, the maximum levels of insurance reimbursements have remained the same since the late 1960's. Many plans offer higher maximums that are comparable to rising dental care costs.
Predetermination of benefits is an administrative procedure that may require our office to submit a treatment plan to the third party before treatment begins. The third party usually returns the treatment plan indicating one or more of the following: patient’s eligibility, covered services, benefit amounts payable, application of appropriate deductibles, co-payment and/or maximum limitation. Under some programs, predetermination by the third party is required when covered charges are expected to exceed a certain amount.
Understanding Your Orthodontic Insurance
1) The total case fee for your orthodontic treatment is submitted to your dental insurance company when treatment begins. The “banding date” is the date on which treatment officially begins; this is the day bands or brackets are placed on the teeth. Placing spacers or separators does not constitute treatment starting.
2) Insurance payments are paid to the orthodontic office either monthly, quarterly, or annually. It is a rare exception that a one-time payment for the entire lifetime maximum is made initially.
3) During orthodontic treatment, if insurance coverage is interrupted for any reason, (i.e. a job change, your employer changes insurance companies, your coverage is dropped, or treatment ends) insurance payments stop. If an insurance change occurs during treatment, it is the patient’s responsibility to inform the office. A new insurance company will not know you are in orthodontic treatment. We must file a claim with the new insurance company and cannot do it if we don’t know about it!
4) When our office confirms orthodontic benefits, the insurance company is very clear that the benefit information we are given is an estimate and no guarantee of payment. In our orthodontic financial agreement, the insurance allowance we take assignment for is an “estimate.” We never know for sure how long or even if we will be paid until it actually happens. If for any reason the total insurance assignment is not paid as expected, it becomes the responsibility of the patient.
5) Our office is happy to file an insurance claim on our patients' behalf; however, once the initial carrier has paid the insurance balance in full, we will be unable to file an additional claim should you become insured with another carrier. We will be happy to provide you with the information you need to file the claim yourself.
At Bucktown Dental we know dental Insurance does not cover the full cost of orthodontic treatment. Therefore, we offer CareCredit. With no up-front costs, low monthly payments, and no pre-payment penalties, CareCredit lest you begin treatment today and pay over time. Apply today.
Bucktown Dental Associates
Dental Insurance Chicago