Insurance/ Financial Responsibilities

  • We accept most insurance plans. If you have any questions regarding your benefits, please   ask our staff prior to your visit.
  • Please bring your insurance information, along with any forms, with you to your appointment.
  • We ask that you pay your co-payment at each visit.
  • We offer payment arrangements; however these must be arranged in advance of treatment.

Due to the many changes in insurance policies, it is no longer an easy task to interpret each individual policy. Although we try to stay aware of the changes, it is not always possible. Therefore, it is your responsibility to know your individual coverage. Failing to do so will result in you, the patient, being responsible for all costs incurred. Please remember that your insurance policy is between you and your insurance company, not between the insurance company and the dentist. If for any reason insurance does not pay in a reasonable time, payment will be expected from the patient. Most importantly, we are here to help in any way we can, and look forward to meeting your dental needs. Again, welcome to our practice!

Understanding your dental benefits is not easy. There are as many different plans as there are contracts. Your employer has selected your plan and is ultimately responsible for how your contract is designed. Remember, whether your plan covers a major portion of your dental bill, or only a small amount, dental benefits are good for patients because they help pay for needed treatment.

It is important to know that each contract will specify what types of procedures are considered for benefits. Even if a procedure is medically and dentally necessary, it may be excluded from your contract. This does not mean that you do not need the procedure. It simply means that your plan will not consider the procedure for payment. For example, cosmetic procedures and implants are often excluded from a dental plan.

It is a mistake to let benefits be your sole consideration when you determine what you want to do about your dental condition.

Many patients have questions regarding their dental benefits. While the employee benefits coordinator where you work can best answer your questions, the following may help.

Insurance FAQ

What insurance companies are accepted?

Delta PPO, BCBS, Blue Care Network, Cigna, Guardian, Humana, United Healthcare, ADN and Dentemax Network.  We dont accept Medicaid or any HMO plans.

Why doesn't my insurance cover all the costs for my dental treatment?

The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost.

But my plan says that my exams and certain other procedures are covered 100%.

That 100% is usually what the insurance carrier allows as payment toward the procedure, not what your dentist or any other dentist in your area may actually charge. For example, say your dentist charges $80 for an examination (not counting x-rays). Your carrier may allow $60 as the 100% payment for that examination, leaving $20 for you to pay.

If my plan does not really cover any procedures at 100%, why does it say it will?

Benefit plan booklets are often difficult to understand. If any part of your plan is not clear to you or if you think something is wrong concerning what your plan covers, you should contact your Employee Benefits Coordinator or the Human Resource department where you work.

How does my insurance carrier come up with its allowed payments?

Many carriers refer to their allowed payments as UCR, which stands for usual, customary and reasonable. However, usual, customary and reasonable does not really mean exactly what it seems to mean. UCR is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing is related to the cost of the premiums and there you are located in your city and state. Your employer has likely selected an allowed payment or UCR payment that corresponds to the premium cost they desire. UCR payments could be more accurately called negotiated payments.

Since the payments are negotiated, does this mean that there s always a balance left for me to pay?

Typically there is always a portion that is not covered by your benefit plan.

If I always have a balance to pay, what good is my insurance?

Even a benefit plan that does not cover a large portion of the cost of needed dentistry pays something. Any amount covered reduces what you have to pay out of pocket. It helps!

I received an Explanation of Benefits from my insurance carrier that says my dental bill exceeded the usual and customary. Does this mean that my dentist is charging more than he/she should?

Remember that what insurance carriers call usual and customary is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment. It is usually less and frequently much less than what any dentist in your area might actually charge for a dental procedure. It does not mean that your dentist is charging too much.

Is there an annual maximum on my benefits?

Yes. Maximums limit what a carrier will cover each year on your plan. Should you exceed your yearly maximum, you will be responsible for paying the dentist the balance for the services you had done.  We make every effort to make sure you dont go over, however, outstanding claims may prohibit us from having an accurate balance at the time services are rendered. It is your responsibility to notify us if you had treatments done in another office or with a specialist.

Why do some benefit plans require me to select a dentist from a list?

Usually the dentists on the list have agreed to a contract with the benefit plan. These contracts have restrictions and requirements. If you choose a dentist on the list, you typically will pay less toward your dental care than if you choose a dentist not on the list. If your dentist is not on the list, this does not mean that something is wrong with the dentist or the office.

 

Why won't my insurance pay anything toward some procedures, such as x-rays, cleanings, and gum treatments?

Your plan contract specifies how many of certain types of procedures it will consider annually. It limits the number of x-rays, cleanings, and gum treatments it will cover because these are the types of treatments that many people need to have frequently.

I know that my insurance plan doesn't go into effect until next month. Why won't my dentist do my treatment today, but send in the claim next month so that the insurance will pay?

State laws regulate these issues. It is insurance fraud to change the dates of service on a claim. Both the patient and the dentist can be prosecuted.


 

Dental floss comes in a variety of colors, materials and even flavors. Waxed varieties slide through the teeth, allowing people with extremely tight spaces to floss more easily. Popular flavors of floss include wintergreen and cinnamon. Waxed floss does tend to fray more than unwaxed floss.

A type of material called dental tape can be effective for people with large spaces between their teeth, or for people with bridge work.

Floss can be purchased in small self-dispensing boxes. Floss can also be purchased in special, single-use holders, which are useful for people who have a hard time wrapping floss around their fingers, including those with dexterity problems or arthritis.


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