As a dental billing company helping dentists improve their insurance processes, we’ve seen many practices make mistakes in calculating patients’ out-of-pocket costs. These errors can lead to frustrated patients and lost income for the practice.

For example, if a patient comes in for a filling, they may assume their insurance will cover 80% of the fee. But what if their insurance downgrades the filling to a less expensive option?


When patients are able to trust that your team is properly calculating their costs, they will be less likely to argue with your practice when it comes time to settle the bill. In our experience, this has resulted in a much more efficient billing process for both patients and dental practices. This is why it is so important to learn how to communicate effectively about insurance complexities.

The Cost Estimator is a tool that allows participants of dental plans insured or administered by MetLife to get an estimate of the cost for a specific procedure in their area. The tool utilizes a fee schedule database and aggregated historical data to provide a range of estimated costs for the procedure in question.

Members can access the tool via Guardian Anytime, their online benefits portal. Once they have logged in, they can select their plan and click on the Dental Cost Estimator link. They can then choose a procedure and enter their zip code to see the estimated costs for both participating and non-participating dentists.

The tool is available to all Delta Dental PPO and Premier groups. Groups that have DeltaCare USA should contact their Sales representative for information about the option to include this tool in their benefits offerings. The estimates provided may vary due to the specific circumstances of the patient and the actual fees charged by the provider, in addition to factors such as deductibles and coverage percentages.

Out-of-pocket expenses

Many Americans avoid seeking dental care due to concerns about the cost of treatment. Even though dental health is a vital component of overall health, the cost of care can add up quickly and may leave patients feeling overwhelmed. The good news is that access to affordable dental care is possible. Having a dental plan can help reduce the cost of visits to the dentist and provide financial peace of mind for patients.

Using the dental cost calculator, patients can estimate their out-of-pocket expenses for a dental procedure. The tool calculates the costs based on the dental plan’s benefits and the patient’s deductible and coverage percentage. Employees can also compare the prices of in-network and non-network dentists to see which one is the best value for them.

While most people will agree that having dental insurance is a smart move, not everyone can afford to pay for an individual dental plan in the long term. Individual dental plans tend to have annual maximums and can be expensive to purchase in the individual market. Moreover, they often require a waiting period to obtain extensive work and can have steep deductibles.

Nevertheless, the fact is that most people do need at least basic preventive dentistry, and going without dental care can lead to much more expensive health problems down the road. Therefore, it is important for employers to offer quality dental coverage and help their employees find affordable options.


Deductibles are the amount of money a patient must pay out-of-pocket for health care expenses before they can be covered by their insurance. These fees can include dental services, like fillings or root canal treatments, as well as prescription medication and travel expenses to and from the dentist. The deductions are subject to the same tax rules as other medical costs. To find out if your expenses are deductible, add up all of your out-of-pocket medical and dental costs for the year and multiply them by 0.075. However, certain expenses are not eligible for deductions, including over-the-counter medications and toothpaste.

In addition to deductibles, patients must also consider other factors when determining their out-of-pocket cost, such as copays and percent coinsurance. Many patients are confused about how these calculations are made, which can lead to frustration for both parties. It’s important to build trust with your patients by being clear about these calculations and how they apply to their specific situation. This will help you avoid billing errors that can result in lost revenue for your practice. If you’re interested in learning more about these complexities, consider signing up for Dental ClaimSupport’s educational platform. It offers tips and tools to help you understand the complexities of insurance billing and out-of-pocket costs. You can also access additional fee information on common procedures in your area.

By Admin

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