Insurance Information

We strive to keep our fees as low as possible for the benefit of everyone. We do not establish our fees on the basis that insurance companies will pay them. Our fees are based on the exceptional skill, time, judgment, professional care, and office environment provided Dr Frank C Perry and his staff. We strive to continuously provide the best care available anywhere in the world on a daily basis regardless of insurance involvement.

Our insurance coordinator is here to help you in obtaining the full 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 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.

Please keep in mind once again your policy is written by your EMPLOYER not your insurance company and your company will seek the plan that is best for them based on the overall group rates.  If you want your benefits changed you must speak to your human resources department regarding your policy.

Many EMPLOYERS continuously shop for new plans and better rates, please make sure you follow up with any changes.  We cannot update your plan information unless you notify us of the change.  It is your responsibility to bring us all the correct information and keep us updated.

Insurance Plans Frank C Perry DDS Participates With

Administrative Services Only, INC (S.I.D.S.)

Aetna Insurance PPO

Aetna Open Access

Assurant Employee Benefits

Blue Cross & Blue Shield (All Except Community Plans)

C.S.E.A.

Careington

Cigna Insurance

Delta Dental 

Dental Health Alliance (DHA)

Dentemax

G.E.H.A.

Guardian

Healthplex

              Specific;  4A Capital,  14C Metro.  31A Independence, 4G Capital,  28A Capital Plus

Island Group Administrators

Stanis Network

Sun Life Employee Benefits

United Concordia

Union Security Insurance

UCR

Insurance companies may also limit their payment by the use of UCR fees. The insurance company select a UCR fee for each procedure and at what percentage the procedure will be reimbursed. For example, a plan with a high premium may have a higher UCR. If a plan has a lower premium the insurance company may set the UCR lower. Your plan booklet may say that they reimburse at 75%, but it is 75% of a number chosen by the insurance company. If an employer wants a plan with lower premiums then by lowering the UCR insurance companies can 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 a fee exceeds the UCR chosen by the insurance company, they will tell you “The fee charged 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.”

Your benefits are decided between your employer and the insurance company. Many needed services may not be 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 the 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 insurance coordinator.

Does My Insurance Cover This?

Many patients have questions regarding their dental benefits.  While the Employee Benefits Coordinator where you work can best answer your questions, the following may help.

Why doesn’t my insurance cover all the costs for my dental treatment?

Dental insurance isn’t really insurance (a payment to cover the cost of a loss) at all.  It is actually a money benefit typically provided by an employer to help their employees pay for routine dental treatment.  The employer uually buys a plan based on the amount of the benefit and how much the premium costs per month.  Most benefit plans are only designed to cover a portion of the total cost.

But my plan says that my exams and certain other procedures are covered 100%

that 100% is usually what the insurance carrier allows as payment toward the procedure, not what your dentist or Dr Perry or any other dentist in your area may actually charge.  for example, say your dentist charges $125.00 for an examination (not counting x-rays).  Your carrier may allow $85.00 as the 100% payment for that examination, leaving $40.00 for you to pay.

If my plan does not really cover any procedures at 100%, why does it say it will?

Benefit plan booklets are often difficult to understand.  If any part of your plan is not clear to you or if you think something is wrong concerning what your plan covers, you should contact your Employee Benefits Coordinator or the Human Resource department where you work.

How does my insurance carrier come up with its allowed payments?

Many carriers refer to their allowed payments as UCR, which stands for usual, customary and reasonable.  However, usual, customary and reasonable does not really mean exactly what it seems to mean.  UCR is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company.  This listing is related to the cost of the premiums and where you are located in your city and state.  Your employer has likely selected an allowed payment or UCR payment that corresponds to the premium cost they desire.  UCR payments could be more accurately called negotiated payments.  

Since the payments are negotiated, does this mean that there is always a balance left for me to pay?

Typically there is always a portion that is not covered by your benefit plan.

If I always have a balance to pay, what good is my insurance?

Even a benefit plan that does not cover a large portion of the cost of needed dentistry pays something.  Any amount covered reduces what you have to pay out of pocket, It helps!

I received an Explanation of Benefits from my insurance carrier that says my dental bill exceeded the usual and customary.  Does this mean that my dentist is charging more than he/she should?

Remember that want insurance carriers call usual and customary is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment.  It is usually less and frequently much less than what any dentist in your area might actually charge for a dental procedure.  It does not mean that your dentist is charging too much.

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