Dental insurance is a contract between your employer and a dental insurance company. Your dental office is not involved in the negotiation of your contract. Dental insurance companies rarely cover 100 percent of any dental fee. Services not covered are based on your contracted amount, and not on what you need or want. Unfortunately, some of the services you need or want will not be covered by your dental insurance. The insurance company only provides your negotiated benefits.

Most dental patients do not realize dental insurance plans have a dollar amount maximum per year. Once that limit is reached, services will not be covered by your dental insurance. We do not want to compromise your care based on restraints placed by an insurance company and your employer.

We realize that dental insurance is complex and can be difficult to understand. That is why we provide full assistance to you. Our office will complete and submit dental insurance claims on your behalf. We will work diligently to make this happen as quickly as possible. Some dental insurance companies take longer than others to process claims. If necessary, our office will contact your company and may request your help with the process.

In most cases, we can begin treatment prior to receiving an authorization from your insurance company. Most insurance companies request prior authorizations but they are not required. It is important to understand that if the dental insurance company denies your claim, you are responsible for all fees.

If you have a question about your dental insurance, please contact our office. It will be a pleasure to serve you.

You should understand how the treatment your endodontist provided works with your dental plan.

What is a UC & R?
UC & R (usual and customary fee) is the amount the insurance company is willing to pay for. The fees are dependent on the region, number of procedures, cost of living, and location of providing doctors office.

Why was my benefit different than I expected?

• I already used my benefits for the year
• My insurance only paid a percentage
• It’s not a covered benefit
• Need to wait for plan’s waiting period to end

Why isn’t the recommended treatment a covered benefit?

Your endodontist provides treatment based on professional judgment not on the cost of treatment. Your plan may not include this particular treatment even if the treatment is necessary.

How do I know what my payment portion will be?

Your payment portion will vary according to the UCR, maximum allowable benefit, and other factors.

How do I understand my Explanation of Benefits (EOB)?

The EOB identifies the benefits, the amount the insurance is willing to pay, and charges not covered on your plan.

How long does it take for a claim to be paid?

Time for a dental insurance carrier to process an insurance claim varies.

Will my endodontist take my insurance?

Some endodontist sign contracts with dental insurance carriers and agree to accept or “take” the payment offered by the insurance company as payment in full, even though it may not be the same amount as the endodontist charges for the procedure. These are considered in network providers in your plan. Other endodontists do not sign contracts but may still accept or “take” insurance company payments. They are not contractually obligated to accept your insurance carrier’s payment as full. You may be responsible for a payment.

What if I still have questions?

Your patient coordinator will do their best to answer all of your questions. There are many plans available and your employer chooses your plan and your benefits.

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St. Croix Endodontics is a Preferred Provider for the following insurance programs:

• Aetna PPO
• Blue Cross/Blue Shield of Minnesota
• Cigna DHMO
• Delta Dental Premier, Options and Preferred
• Delta Dental Singular Program
• Delta USA
• DHA
• Formula
• Health Partners
• Preferred One DHMO
• Premier Plans
• WEA
• 5% savings extended for payment in full. Cash or checks only.

St. Croix Endodontics will accept and submit for most other insurance programs with the exception of Medical Assistance Programs.*

Please note that we cannot guarantee insurance coverage for our patients. Please confirm coverage with your provider prior to scheduling your appointment.

*St. Croix Endodontics, PA is not a Medical Assistance Provider and cannot submit for these programs.

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