Insurance Information

staff at a desk

We strive to keep our fees as low as possible for the benefit of our patients. Our fees are established based on the exceptional skill, time, judgment, professional care, and office environment provided by Dr. Gouldin and Dr. Carlos, as well as their staff. Our commitment is to continuously provide the best treatment available, regardless of insurance involvement.

Our financial coordinators are here to help you obtain the maximum benefits you are entitled to under your dental insurance plan. There are hundreds of dental insurance plans in existence and some of these companies change policies and guidelines weekly. Therefore, we encourage you to bring all of your insurance benefit information, including your booklet, forms and insurance card, to your appointment, and to keep us informed of any change to your insurance.

Pre-treatment estimate

Before any treatment is rendered, we can submit a pre-treatment estimate to your insurance company with the supporting data necessary (periodontal charting, xrays,). The company will let us know what your insurance policy covers. Your insurance company may work to limit their liability through the use of frequency limitations, yearly plan maximums and their UCR (usual and customary rate). Please note that a pretreatment estimate is not a guarantee of payment.

UCR

As stated above, insurance companies may limit their payment by, among other things, the use of UCR fees. The insurance companies select a usual and customary rate (UCR) for each procedure, and a percentage at which the procedure will be reimbursed. So while your plan booklet may say that the company will reimburse at 80%, that means 80% of a fee chosen by the insurance company, not 80% of our fee.

If an employer wants a plan with lower premiums, then the insurance company might lower the UCR to reduce the cost of the premium to the employer. If the UCR is lower, this can increase the patient’s out of pocket expenses. (We often see a variety of UCR’s from the same insurance companies for different employers.) If our fee exceeds the UCR chosen by the insurance company, they will tell you “The fee charged by your dentist exceeds the usual, customary and reasonable fee charged in your area”. This is not necessarily the case. It may be more accurate to say, “The employer chose a plan that does not reimburse at the level charged by most dentists in the area.”

So you can see, your benefits are decided between your employer and the insurance company. Many needed services are often not covered. Our office will do everything possible to help you understand and make the most of your dental insurance benefits. Please remember that you are ultimately responsible for all expenses incurred. We urge you to read your insurance policy so that you are fully aware of coverage and any limitations of the benefits provided.

We hope you found this information useful. Insurance matters are often complicated, so if you have any questions regarding your coverage, please feel free to talk to our financial coordinators.