Almost all dental insurance companies work on a percentage basis (this is why you can only estimate their payments). The percentage paid is based on the insurance plan of a particular group or individual and varies widely. I recommend that all insurance should be verified prior to the patient arriving at your practice.
There is almost always a deductible that your dental patient has to meet before the insurance percentage kicks in. The deductible varies widely from plan to plan.
To calculate the insurance benefit Cambridge Dental Consultants recommends that you take the estimated insurance allowance and multiply it by the percent the insurance company will pay. The total gives you the estimated insurance benefit.
(Estimated Allowance) x (percentage pd. by insurance co.) = insurance benefit.
EXAMPLE: $60.00 filling X 80% = $48.00 paid by the insurance company.
If the deductible hasn't been met, you must subtract the deductible FIRST. Then multiply it by the percentage.
EXAMPLE:
$385.00 Crown
-$50.00 Deductible
________________
=$335.00 left multiplied by 50% (% paid by ins. co.)
=$167.50 paid by insurance.
=$217.50 Patient Portion ($167.50 + $50.00)
Almost all insurance is calculated in this manner. The patient part for the treatment is collected at the time of service, unless otherwise arranged by your dental practice’s accounts manager.