Dental insurance companies use several factors to determine their "allowed" or "approved" payments for procedures, which often differ from the actual fee charged by West Augusta Dental Associates or other dental practices.
Insurance companies typically create a fee schedule based on what they consider "usual, customary, and reasonable" (UCR) charges for dental procedures in our Augusta, GA, region. These UCR rates are calculated using data collected from various practices, often averaged, and then adjusted downward. The insurance company calculates your benefits using this internal fee schedule, not our actual fees.
Understanding Network Dental Coverage
For in-network providers, these allowed amounts are contractually agreed upon. Since West Augusta Dental Associates is out-of-network with many plans, there's often a difference between our actual fee and what your insurance considers their allowed amount.
Your specific plan details also influence payment calculations. Plans vary in coverage percentages (typically 50-100 percent, depending on the procedure category), annual maximums, deductibles, waiting periods, and exclusions. These factors affect the final amount your insurance will pay.
Our team works diligently to help estimate your insurance coverage before treatment, but these are always estimates since insurance companies don't guarantee payment until claims are processed.
Contact Our Augusta, GA, Dental Office
If you have questions about how your specific plan calculates payments or need help understanding your benefits, please contact us at (706) 738-8070. We're committed to helping you maximize your insurance benefits while receiving the quality dental care you deserve.