Insurance Terminology Explained In Easy Language
Insurance lingo is confusing. We've created this guide to clarify definitions of commonly used dental insurance language. We are always available to help our patients navigate their insurance plans and benefits, so feel free to call us anytime.
What is meant by "contracting with insurance companies" or being "in-network?"
Some dentists are in a 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 in order to offset the discount/write-off required by the insurance company. It may result in shortening the time available to each patient and reducing quality in 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 be in a contract with insurance companies. We are "out-of-network." We choose to offer claim processing and submission to insurance companies so we can provide the highest level of customer care related to insurance. We will process and submit to any/all insurance companies which 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 they also choose not to process your insurance claim. They will give you a "superbill" or receipt, and you will be on your own to submit and process your claim with insurance. We don't consider this to be in our patients best interest. Dental insurance billing is often very complicated. It is something that the general public would prefer not to do on their own. However, it saves costs to dental offices to have patients file themselves as it cuts their 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: "usual and customary," "fair and reasonable," "fee schedule," "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 to see. 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). It leads to better overall coverage. Better quality insurance policies use this language.
Some insurance companies use what is called 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 on your side as a patient, and our side as dentists.
Please give us a call, and we will be happy to go over your dental plan. We can answer any questions, as well as provide explanations, for any aspect of your insurance which remains confusing for you. We are always here to help! 303-802-4313