Understanding Your Dental Insurance
We will file ANY INSURANCE as a courtesy to our patients, regardless of whether we are participating providers (“in-network”). We are currently in network with the following insurance companies: Delta Dental Premier, Metlife, United Concordia Tricare, and South Carolina Medicaid.
We understand that the difference between in-network and out-of-network providers can be confusing, so please let us explain. We find that most patients do not see a difference in overall costs whether or not our practice is in-network with their specific insurance company. Most dental insurance plans are Preferred Provider Organization (PPO) plans. This means that you can choose an in-network or out-of-network provider, and the plan will still cover and pay for provided services. Insurance companies simply recommend in-network providers because it saves them money.
In-Network
An in-network provider means that the dental practice has made a deal with the insurance company, agreeing to accept prices set by the insurance company. Often, these prices do not even cover the cost of the procedure. This means that if the dental practice’s fees exceed the “Maximum Allowed Amount” designated by an insurance company, the dental practice must write off the difference. For preventive and diagnostic treatment (a normal cleaning appointment), this means your out-of-pocket costs should be little to nothing. This does NOT mean that there will never be out-of-pocket costs. There is still a deductible to be met and a co-pay of 20-80% on restorative procedures–in addition, some procedures are not covered at all, regardless of whether a practice is in network.
Out-of-Network
If you visit an out-of-network practice, this simply means that if there is a difference in the practice fee and the “Maximum Allowed Amount” of your insurance company, you would be responsible for the difference. HOWEVER, our fees at Jackson Pediatric Dentistry are set at the usual and customary rates for the zip codes in the Summerville area, and they are usually still within or very close to the Allowable Fees set by the major insurance companies. This means that for most out-of-network patients, your out-of-pocket costs for preventive and diagnostic treatment (a normal cleaning appointment) would still be little to nothing.
Also, keep in mind that, by using an out-of-network practice, the insurance company cannot dictate your child’s treatment. For example, some insurance companies will not pay for composite (tooth-colored) fillings or for esthetic white crowns. They would require that your child have silver fillings or crowns. An in-network provider would downgrade these services to the lower fee, and you would be responsible for the difference, in addition to your normal co-pay. If you use an out-of-network provider, your insurance will likely still cover these procedures without a downgrade in payment, requiring only that you pay your co-pay portion.
We will verify your specific insurance coverage, estimate your out-of-pocket costs, and submit your benefits on your behalf as a courtesy to you and your child. Please feel free to contact us with any questions concerning your specific insurance plan, and we would be happy to help!
