Insurance can be extremely helpful when you are in need of dental work and in most cases it will cover your basic cleanings and exams every 6 months. Unfortunately, it can also be extremely convoluted and confusing to many people.
Have no fear we are here to help. Below you will find some of the most common questions and misconceptions about insurance.
Do you accept insurance?
The most simple answer to this question is - Yes. We are in network with most PPO insurance. Please find the most common insurances accepted at our office here.
We are not in network with HMO or DMO insurances, Medicaid, some smaller PPO plans, and some TriCare Plans.
We will always verify your insurance prior to your visit. To do so we will gather your information or request a copy of your insurance card prior to your appointment. This will typically include your insurance provider, your employer's name, your group ID, your member ID, and in some cases your social security number.
I have secondary insurance coverage so why am I paying co-pays?
Having secondary insurance can be a huge benefit in some cases but it does not mean that you will not have any out of pocket costs for your dental treatment. Secondary insurance can reduce the cost of your treatment but it typically does not cover the remaining balance left over from your primary. It can also be somewhat frustrating to understand.
Here is an example of how it works: When we bill out $400 to your primary insurance for treatment and they say, yes we will pay up to 50% and the patient is responsible for the remaining 50% totalling $200. We will then send that information to your secondary insurance. They will look at what the Primary paid toward your treatment and make a decision based off of your coverage and plan with them. In this case your secondary insurance says “We cover that treatment at 80%.” So your secondary insurance will pay an additional $120 toward the total balance due. This leaves you with a patient responsible balance of $80, whereas if you simply had your primary insurance your total patient responsible balance would come to $200 due.
Will you submit a claim to my insurance or will I?
As a courtesy to our patients we will submit a claim to your insurance and will handle all inquiries for more information. We will do everything that we can to get your treatment paid for if it is listed as a covered benefit, including appealing the claim if it is denied. Unfortunately, in some cases, insurance will still find a reason to deny your treatment. If this happens the remaining balance will transfer to patient responsibility and will need to be paid for by you. We will provide you with everything that you will need to appeal the denial as a patient after this happens.
I already paid for my treatment at the time of my visit, why am I getting a bill 3 months later?
Ultimately your insurance is the one to determine the amount that the patient is responsible for to the dentist. We do our best to estimate what your portion will be at the time of your treatment based on the information that has been made available to us by you and your insurance company. The amount that we are collecting at the time of treatment is just an estimate. There could be several factors that cause you to have a bill after your insurance has paid their portion including; we estimated incorrectly, they applied a portion to your deductible, the treatment was not a covered benefit, there was an age limit on the treatment we were not aware of, and a variety of other reasons.
If your insurance pays their portion and states that you are responsible for a specific amount and we did not collect that amount then you will receive a bill from us. If you paid more than that amount then we will place a credit onto your account for you to utilize at your next visit or you may request a refund.
Why do I have to pay at the time of treatment when you are billing out to my insurance?
This is a standard practice in dental offices across the nation.
We collect the estimated copay at the time of treatment to make the billing process easier on everyone involved.
I don’t have dental insurance…what are my options
Not having dental insurance just got a lot simpler. We offer our Performance Dental Center Plan. It is a yearly plan that will provide you with a slew of benefits. Please find the details here.
You can also pay completely out of pocket for your treatment. The cost will depend on what treatment you are needing and will be based on the areas UCR (Usual Customary Rate).
My Insurance Provider sent me a statement saying I owe you money…why?
This is called an Explanation Of Benefit or EOB. An EOB is the breakdown of how your insurance company determines what you are supposed to pay to your dentist. These can be quite confusing because you may receive one that says you owe more than what you actually owe. This is not a bill from us or a guarantee that you will owe us any money. If you receive one of these in the mail please give us a call and we will let you know if you have any outstanding balance on your account, do not send any money in for payment. You can also check your patient portal here and see if you have an outstanding balance.
You said my treatment would be covered.
We are here to help in every way possible with your insurance billing needs, however, we do not work for your insurance company and it is ultimately the responsibility of the patient to know the finer details of their insurance benefits, as that information is not always freely or completely given to us by your insurance provider when calling to verify your benefits. The only surefire way to make sure your treatment will be covered is to pre authorize your procedures which we are happy to do for you. The pre authorization process can take up to 6 weeks depending on how fast your insurance works. If you would like a Pre Authorization or Pre Determination done just let us know and we are happy to get that out for you.