Our office is located on Main Street in Lakemont Park at 166 Lakemont Park Boulevard in Altoona, Pa 16602     Directions/Map

Dental Insurance Benefit Details

Dental Insurance is rapidly playing a larger role in helping people obtain dental treatment.  Since we strongly feel our patients deserve the best possible dental care we can provide, and in an effort to maintain a high quality of care, we would like to share some information about dental insurance with you.

Insurance companies have a large number of dental plans available.  Plans provide a specific level of monetary benefit as well as cover specific types of procedures.  Better plans offer a higher percentage of reimbursement and cover more procedures.  Lesser plans provide a lower level of reimbursement and exclude many dental procedures.  The better plans are more expensive to your employer and to their employees and as a result most plans do not provide 100% coverage.

Dental insurance companies are out to make a profit and they limit paying benefits by establishing annual dollar maximums for dental care.  Most plans have a $1,000 limit per member per calendar year.  Plans also establish reimbursement limits for specific dental procedures.  These procedure limits are called a UCR.  This procedure limit minimizes the amount of benefit the insurance company has to pay by limiting the office fee as shown below.

Plan Office Fee Insurance UCR Insurance Benefit Reimbursement

A $100 $90 80% $90 x 80% = $72

B $100 $100 80% $100 x 80% = $80

Instead of paying 80% of the office fee, insurance company A pays 80% of their arbitrary amount called the UCR fee.  Insurance companies like plan A claim that their fee is “usual, customary and reasonable”, but their fee doesn’t take into account for treatment in the office of a dental specialist such as a Periodontist.

Insurance plans also limit access of patients to dentists and dental care by establishing dental participating networks.  Dental offices that participate with dental insurance companies allow the insurance to dictate patient treatment based on the dental plan and not a patient’s level of disease or treatment needed.  Due to the limits that dental insurance companies place on reimbursement and treatment options, this office is not a participating office with dental insurance companies.  

Our fees are based on the complexity of therapy and your needs and dental goals.  The type of treatment you need and receive from us is based upon our professional judgement and not whether you are covered by a dental plan.  We do not believe it is in your best interest to compromise care to an insurance plan that is less than optimal.  We believe that the patient after a discussion of treatment options with their dental profession should be making the treatment decisions.