Insurance Information

Dr. Keiser participates with Aetna Dental PPO, Cigna Dental PPO (*not Cigna Dental PPO Advantage), Delta Dental PPO, Guardian DentalGuard PPO and MetLife Dental PPO/TriCare Dental PPOs.

For your information…..

• The total fee is your responsibility.
• Information we receive from insurance companies can be inaccurate and not updated in real time.
• We urge you to personally contact your insurance carrier.
• If we participate with your dental insurance, your final balance is determined after your insurance has been paid, and will be charged to your credit card on file with us.

It is always the patient’s responsibility to be familiar with the conditions and limitations of their insurance. Your insurance is a contract between your employer and an insurance company. The goal of most insurance policies is to provide basic care for very specific services. The benefits you receive and the services covered depend on the terms of the contract negotiated by your employer and the insurance company. Please realize that our office has no control over nor influence on the professional services that may be covered.

All insurance policies have limitations. It is your responsibility to understand these limitations. If you are uncertain about the extent of your coverage, speaking directly to your insurance company is the most effective way for you to clarify your benefits. Insurance companies are always eager to respond to their insured since your employer pays their premiums. We understand that insurance can be confusing; therefore, we always urge our patients to personally contact their carriers and be familiar with the conditions and limits of their policies. For those insurance carriers in which Dr. Keiser participates, we will electronically submit your claim for you, and your copay is not required on the day of your visit but you must leave your credit card number on file which will be used to automatically process your copay after your insurance company processes your claim.

If you have dental insurance coverage with a company other than those listed above, payment in full is due at the time of your visit.  We will provide forms for you to submit for reimbursement for any coverage you may have.

BENEFITS ARE NOT DETERMINED BY OUR OFFICE.  Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all fees. However, most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.  A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.  Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.  Unfortunately, insurance companies imply that your dentist is “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

If you require an estimated charge for our services or if your insurance company requires pre-authorization, you should schedule a consultation and advise us if you need a predetermination.  Following your consultation, we will then provide an estimate for you so you can forward it to your carrier for determination of coverage.

Dr. Keiser does not participate with medical insurance; therefore, it is the patient’s responsibility to contact their carrier to determine coverage as certain types of oral surgery (e.g., bony impacted third molars and some types of growths) may be covered by both dental insurance as well as medical insurance.

Medicare: Medicare does not cover procedures related to teeth; however, it is important to know that procedures not related to teeth may be covered by Medicare, if the patient is seen by a participating provider. Dr. Keiser does not participate in Medicare; therefore, the patient would be responsible for all charges without any reimbursement from Medicare and/or supplements.