Every insurance is different. When your employer sits down with an insurance carrier, they determine what plan you are going to be on and the benefits. If you have an individual plan that you purchased on your own, most often there are waiting periods with little reimbursement. There is no regulation as to how insurance companies determine reimbursement levels, resulting in wide fluctuation. Insurance companies are not required to disclose how they determine these fees. Subscribers are generally told that the insurance determines their fees by zip code and that the doctor's fees are higher. (this is not true). The American Dental Association (ADA) has actually investigated how often fee schedules are updated. They found that most often they are only done once in every 10 to 20 years. The exception is Delta Dental, they update their fees yearly to determine the maximum amount in which they will pay.
This answer was written by Priscilla, our office manager. She is responsible for insurance billing and is very knowledgeable on this subject. If you have insurance questions for Priscilla, she is very excited to answer them! Please leave your questions in the comment field and Priscilla will respond.
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