Insurance lingo can be confusing. We've created this guide to clarify the definitions of commonly used dental insurance terms. We are always available to help our patients navigate their insurance plans and benefits, so feel free to call us anytime.
What does "contracting with insurance companies" mean, or being "in-network?"
Some dentists are under contract with insurance companies. To be "in-network," the insurance company requires the dentist to discount their fees in exchange for the possibility of more patients choosing their practice. As a trade-off, many dental offices that are "contracted" or "in-network" with insurance companies find themselves needing to make changes by seeing a higher volume of patients and reducing the quality time spent with patients to offset the discount/write-off required by the insurance company. It may shorten the time available to each patient and reduce the quality of labs and materials.
"Taking insurance," "Working with insurance," or "Accepting insurance."
Being in-network affects the quality of care dentists can provide to patients. Because of this, we have chosen not to enter into contracts with insurance companies. We are "out-of-network." We decided to offer claim processing and submission services to insurance companies, providing the highest level of customer care related to insurance. We will process and submit to any/all insurance companies that provide both "in-network" and "out-of-network" benefits. It isn't related to having a contract with an insurance company. The insurance company would apply "out of network" or "not contracted" coverage.
Some offices are not only out-of-network but also choose not to process your insurance claim. They will provide you with a "superbill" or receipt, and you will be responsible for submitting and processing your claim with the insurance company. We don't consider this to be in our patients' best interest. Dental insurance billing can be quite complicated. The general public would prefer not to do it on their own. However, it saves dental offices money by having patients file their own paperwork, thereby cutting administrative costs.
At Studio Z Dental, we will save you the time and hassle of dealing with insurance companies by helping you with your dental claims.
Insurance contract language includes "usual and customary," "fair and reasonable," "fee schedule," and "maximum allowable."
"Usual and customary" or "fair and reasonable" are contract language used to describe how the insurance company pays out-of-network claims. These are both positive. They mean that the insurance provider will base the out-of-network coverage on the fees in the immediate physical area of this office (based on average costs per zip code). This leads to better overall coverage. Better quality insurance policies use this language.
Some insurance companies use a "fee schedule" or "maximum allowable fee." Generally speaking, this means the out-of-network coverage will not cover as much. The "fee schedule" and "maximum allowable" policies cover less than "usual and customary" and "fair and reasonable" contracts. Less expensive insurance policies lean in this direction.
We hope this helps you understand some of the dental insurance terms, both from your perspective as a patient and from our perspective as dentists.
Please call us; we will be happy to review your dental plan. We can answer any questions and explain any aspect of your insurance that remains confusing. We are always here to help! 303-802-4313