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Sunnymead Dental Group Policy Regarding Dental Insurance

We file insurance claims as a courtesy to our patients. When we receive your insurance information on the day of your visit, we will be happy to file your claim for you. Please keep in mind, we do not have direct contact with your insurance company – only you do. Your payment to Sunnymead Dental Group will be the estimated amount insurance is not expected to pay.

Claims are filed by Sunnymead Dental Group electronically, so your insurance company will receive the claim on the day of your appointment during the business week. Your insurance company is required by law to pay each claim within 30 days of receipt. Patients are responsible to pay any balance on your account after 30 days, whether your insurance has paid your claim or not. Balances left unpaid after 60 days are subject to a re-billing fee of 1.5%, added to your amount owed each month until paid in full. Patients will be refunded if their insurance pays Sunnymead Dental Group directly.

We assist our patients in estimating your portion of the treatment cost. We are unable to guarantee what your insurance will cover or not cover as a result of each claim Please note, because we do not have direct contact with your insurance company, we are not responsible for how they handle claims or the amount of benefits they pay on a claim. Sunnymead Dental Group is not responsible for errors in filing your insurance claim, as these filings are done as a courtesy.

Dental insurance does not pay 100% of all procedures. Although many people think dental insurance pays 90%-100% of treatment, most plans typically only cover an average of 50-80% of the total fee. Coverage is typically determined by the plan you or your employer has selected, including the amount you have paid for coverage or the type of contract you or your employer has negotiated with the selected insurance company. Your dental insurance benefits are not determined by Sunnymead Dental Group.

In some cases, your dental insurer will reimburse you or the dentist directly at a lower rate than the dentist’s treatment fee. Insurance companies will sometimes state that the reimbursement was reduced because the dentist’s fee exceeded the typical cost of services, or “reasonable fee” (“UCR”). This results in the misconception that dentist fees are unreasonable. Please know this language is misleading and inaccurate. We pride ourselves on trusted, competitive pricing, with no hidden fees.

Insurance coverage and fees vary widely. Each insurance company uses a different set of fees that are considered “allowable,” often based on regional data that is 3-5 years old. Additionally, “allowable” fees are often set by insurance companies to ensure they make a 20-30% net profit. Therefore, “UCR” Fees are typically based on arbitrary data and are misleading to patients.

Please keep Sunnymead Dental Group up to date with any changes to your insurance, including policy name, insurance company, or change in employment. While we do not have direct contact with your insurance company, we will strive to help you navigate your estimated costs of treatment.