At Peachtree Children’s Dentistry in Gainesville, every policy is crafted with care. Our goal is to ensure your child’s dental journey is smooth, safe, and memorable. Questions? We’re here to assist!
Insurance companies often reimburse at rates lower than a dentist’s fee, citing that the fee exceeds their “usual, customary, or reasonable” (UCR) rates. This might suggest that fees higher than what the insurer pays are unreasonable. However, this is misleading.
Each insurance company determines its own UCR rates, often based on outdated data. These rates are set to ensure the company’s profitability, sometimes aiming for a 20%-30% profit margin. It’s essential to recognize that a lower reimbursement doesn’t mean your dentist is “overcharging.” Instead, it often indicates that the insurance’s benefits or UCR rates are on the lower side.
When determining dental benefits, it’s crucial to account for deductibles and co-payment percentages. For instance, if a service costs $150 and the insurance’s UCR rate matches this, you’d first subtract a typical deductible (e.g., $50), leaving $100. If your plan covers 80% of this amount, the insurance would pay $80. This means you’d be responsible for the remaining $70. If the UCR is lower or coverage is only 50%, your out-of-pocket cost would be higher.
Absolutely love this dentist! Everyone from the staff to the Dentist himself have
been amazing! My son has been going here for several years and they have
always made him feel comfortable and at ease. Sadly, we are moving and it will
definitely be hard to find another dentist office for my son as amazing as
Peachtree Children’s Dentistry!
The most amazing dentist and staff I have ever been to for my children!!! My
kids came to the office with a huge fear and it changed immediately. They were
so patient and kind. We will never go anywhere else.
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