Dental Insurance

We’ll help file any insurance claim. Please read and understand your rights and responsibilities to get the most out of your policy.

Murray Hill Pediatric Dentistry is proud to be in-network with the below insurance plans. However, we also accept and process paperwork for all major PPO’s, with little or no out-of-pocket expense for the most common preventive and

Important note: Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment. Coverage and participation cannot be guaranteed until insurance is verified.

Dental Insurance Guidelines for Our Patients and Their Parents

We provide an insurance coverage estimate to our patients’ families; and we will help process any dental insurance claim as long as we receive all insurance information from you by the day of the appointment. Our estimate is not a guarantee that insurance will pay exactly as estimated. Insurance coverage is subject to limitations, exclusions, waiting periods, frequency, age restrictions, deductibles, and maximums. These limitations may change from benefit year to benefit year. We will do all we can to ensure our estimate is as accurate as possible, but your insurance company and your child’s plan benefits ultimately determine the amount covered.

On the day of service, you’ll be responsible for all charges not expected to be covered, including co-pays, deductibles, and balances not paid by insurance. If, after 45 days, the insurance carrier has not remitted payment to us and a balance remains on your account, you will be responsible for payment. If we receive payment from the insurance company after 45 days, and you have already paid us, we will send you a refund.

We are not in a position to negotiate with your insurance company, as their relationship is with you (or perhaps your employer), not us. All charges you incur with us are ultimately your responsibility, regardless of your child’s insurance coverage. If you have any doubts, questions, or concerns about your child’s exact coverage, please contact the insurance company for the details of their benefits.

Although rare, some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.

Dental Insurance Secrets We Want You to Know

Here are a few open secrets about dental insurance coverage that may surprise you. This information should help clarify things if you receive an explanation of benefits or a bill that isn’t what you expected.

No insurance pays 100% of all procedures. Unfortunately, dental insurance just isn’t that robust. Most plans only pay between 50 and 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.

Benefits are not determined by our office. 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.

This may create the impression that any fee greater than the amount paid by the insurance company is unreasonable, or above what most dentists in the area charge for a certain service. Insurance companies set their own schedules, and each company’s UCR for a given service is different for a few reasons:

• Each insurance company collects fee information from the claims it processes and determines the allowable UCR fees using the company’s own formula.
• The data they’re using to determine the allowable rate for a given service may be up to five years old.
• For better or worse, insurance companies are businesses and therefore must make a profit.

The language around this method (usual, customary, reasonable, etc.) can imply that your dentist is overcharging, but we want to clear this up. Naturally, insurance companies set their UCRs as low as possible, with less expensive policies generally ranking lowest overall in terms of claim payment. Meanwhile, we think you’ll find our prices to be comparable to those of similar practices around NYC.

Deductibles and co-payments must be considered. When estimating dental benefits, deductibles and percentages must be considered. Even the most conscientious insurance consumers may find their policy covering less than they expected.

To illustrate, let’s say the fee for service is $150.00. If the insurance company allows $150.00 as its usual and customary (UCR) fee, you may expect the policy to cover the entire amount, but this is where deductibles and percentages come in. If your deductible is $50, that leaves a coverable amount of $100.00. Remember, dental insurance rarely covers 100% of anything, so let’s say you have a pretty good plan that pays 80% for this particular procedure ($80.00), leaving a remaining portion of $70.00 to be paid by you.
Of course, if the insurance company’s UCR is less than $150.00, or your plan pays only 50% of this procedure, then the insurance benefits will also be significantly less.