Alternate Benefit Clause. Who does it help?


We get asked so many times - "why does my insurance not pay 50% like my policy states?" Unfortunately, the insurance companies have come up with a method that allows them to change the code of the service your received to a lesser quality service code. They then apply any outstanding deductibles and then apply their applicable percentage (for example - 50% is standard for most crowns). This will then let them pay 50%, but on a lesser fee. Then the patient has to pay any outstanding deductible AND the 50% PLUS the difference between the service actually received and the fee that the insurance company changed it to. Confusing? Yes, and this is only one of the things they do to keep more of your money. 




You Might Also Enjoy...

COVID-19 Response

Our office always has met and will continue to meet and exceed the CDC guidelines for infection control. There is no factor more important in this decision than the health and well being of our patients, our staff, and our families.

Whitening MythBusters

What stains your teeth? Could it be that morning cup of coffee? That lunchtime bowl of soup? Read the article for lots of facts. If you are considering Whitening your teeth - give us a call to have a consultation to see if you are a candidate!

Dental Insurance Enrollment for 2021

These are some ideas if you are considering purchasing your own dental plan/discount plan. Discount plans are just that - they allow you to get the same discount on your dental treatment as someone in the plan. Those plans are NOT insurance.