Cary Pediatric Dentistry
Robert D. Elliott, D.M.D., M.S.
Julie R. Molina, D.D.S., M.S.

540 Waverly Place, Suite 300
Cary, NC 27518
(919) 852-1322

Regular office hours:
M-Th: 8:20am-5pm,
Closed for lunch 1pm-2pm
Fridays: 8:20am-3pm

Summer office hours starting
May 31, 2016 – July 15, 2016
M-F: 8:20am-3pm 

Dental Insurance and Our Office

Our Office Policy Regarding Dental Insurance

Our office is considered out of network for all insurance companies. Therefore, our parents pay us directly for the services rendered at the time of the appointment. We in turn give the parents a general claim form to send into their insurance company for reimbursement.

 

The top two misunderstood facts regarding dental insurance are:

 

Fact 1 – No insurance pays 100% of all procedures.

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company. There are literally thousands of contracts available for employers to choose from.

Fact 2 – Benefits are not determined by our office.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit. You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Unfortunately, insurance companies imply that your dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low.

In general, the less expensive insurance policy will use a
lower usual, customary, or reasonable (UCR) figure.

Our mission is to provide specialized and comprehensive care for infants, children, and adolescents in a friendly, safe, and state-of-the-art environment with a focus on prevention and education for the families. Dr. Elliott, Dr. Molina, and our TEAM are here to positively change this generation’s view of going to the dentist, one child at a time.