Frequently Asked Questions
We hear that question a lot in our Matthews dental office – it’s a good one. Our philosophy of patient-centered care is likely different from many dentists that you may have seen in the past. We feel that you and your family deserve more than someone who is merely ‘looking for holes’ to drill and fill. Instead, we look at the big picture in order to develop a long-term plan of health that is customized just for you. It wouldn’t be smart to build a house without a blueprint. In the same way, it is not smart to perform expensive dental treatments without first making a good set of plans.
Just like an architect will evaluate a building site thoroughly before starting to make a design, our first appointment is used to gather all the information needed to put together a “blueprint” for your dental health.
You are not alone. We have many patients in our “family” that are also afraid. The first step is to come in and see us. Make your new patient examination appointment and we can get all of the diagnostic information we need to help you make a good choice on how to proceed. We can then discuss the various levels of sedation we offer so you can get the treatment you deserve in the way that fits you best.
Our doctors are fully licensed to practice in North Carolina. Our staff is our most prized possession! Every one of them is trained and licensed and they are experts in their field. Our office meets or exceeds all of the standards set by the North Carolina Board of Dental Examiners and the North Carolina Department of Labor. In addition, we pride ourselves on the cleanliness of our office and the strict adherence to disinfection and radiation exposure standards set by the state and federal government.
Generally, a full set of radiographs or a panoramic radiograph should be taken every 3-5 years. Bitewing, or checkup, radiographs should be taken every year. In our office, we balance the diagnostic need against the radiation dosage. There is no cookie-cutter approach. We have spent over$200,000 for digital equipment which allows us to get the information we need to take care of you using minimal radiation. If you have images to transfer that are of good diagnostic quality, we are happy to use them. There is a transfer request form that you may print and sign in the front desk section of our website. We are here to help but ultimately, you are responsible for the transfer of your x-rays BEFORE your appointment day if you want them to be used. If we do not have diagnostic quality radiographs for your examination appointment, it is in the best interest of your health that we take new ones or reschedule. No treatment can be performed without proper diagnostic information. Why would you risk missing a tumor, a cyst, a cavity, or infection which could have been seen with such a simple procedure?
We offer early morning appointments starting promptly at 8:00am. We also offer extended-time appointments so that you can get more treatment finished with less time off from work. If your schedule changes often (like pilots or contract workers), we offer same-day VIP appointments on a first-call basis. Call us as soon as you know you have a free day. If we have a schedule change, you will have priority to be added to our day! Lastly, our office generally runs on time. You will not be waiting two hours for a half-hour appointment so you can plan the rest of your day without worry.
DMO coverage is the least expensive coverage that can be bought by you or your employer. Clinics that sign up for these plans get paid a set monthly amount (called capitation) for every patient that signs up. While the premiums may be $20-40 per month, the capitation amount is usually $7-10 per month with the difference going to the insurance carrier. The dental offices sign a contract that they accept the capitation payment and, in turn, waive their fees for basic services and drastically cut their fees for everything else. Because of this, they do not get paid to see you for preventive or basic services and can only charge you if they find more advanced problems. More correctly, they get paid NOT to see you for basic services because if you actually go, their cost to treat you is higher than the capitation payments. This is why we don’t participate. Let your employer know that a PPO or traditional plan is only between 5 and 15 cents more per day and you want to go to a doctor that you choose.
We are currently accepting new patients in our practice.
You may pay your bill by mail with a check or money order or, in person. We also accept Mastercard, Visa, Discover and Amex and you are welcome to pay by telephone or by using our patient internet portal. Lastly, if you have a Carecredit, Chase Credit or similar, you may authorize payment by telephone as well.
It is standard practice for a store to bill a customer the day that they buy something. In the same way, our system calculates the number of days your balance is outstanding from the day we performed the treatment, not from when your insurance company makes their determination. If your carrier has delayed their decision by 60 or 90 days, your account balance may show as delinquent when the claim is closed. We apologize for any inconvenience this may cause.
We process credits every 2-3 weeks for accounts where all outstanding claims have been closed. Unless you specify otherwise, we will promptly send you a refund check for the amount that was overpaid.
An EOB stands for “Estimate Of Benefits” and is a statement from insurance company which is generated whenever a claim or pre-estimate is filed on your behalf. Your member booklet, human resources department or your insurance carrier can better explain how to read your EOB as they are all different. In general, it will show you the submitted amount, the insurance downgrades (if any), the percentage of coverage and your financial responsibility. Downgrades or exclusions will usually be coded with a letter or number. A key can be found somewhere in the EOB package which details the reasons for those exclusions. Please remember that you will recieve your EOB up to 3 weeks before we will.
The financial obligation for your dental treatment is yours. The insurance company is responsible to you, and not to our office. We will assist you in any way that we can, but please know that we do not work for any insurance company and therefore cannot guarantee their payment. Once your carrier has paid the claim, any difference will be due upon receipt of our statement. If, for any reason, we have not received your insurance carrier’s payment within 90 days after submitting the claim, the remaining balance will be due and payable by you. Balances over 90 days old are subject to 18% APR.
There are a few times that your carrier may make a mistake with your claim (not many). Generally, claims are automated and electronic. Your carrier’s computers simply apply the rules that you have paid for with your plan and pay accordingly. If the service is not covered by your plan, it will likely not be paid regardless of how earnestly you believe it should. Some claims for more complex procedures are hand reviewed. Despite what you might think, they are not reviewed by a doctor the first time in most cases, just a data entry clerk. In these cases, if you request that the company re-review your claim with a consultant, they may reopen the claim for you. Usually they will then require more information. Make sure that you keep a record of all correspondance and make a list of what you will need. We will be happy to send you the information you need to refile your claim. If you get any additional payment sent on your behalf, we will credit your account appropriately and refund any excess amount.
- Although we do maintain computerized histories of payment by a given company, they change often. Insurance companies are not required to notify us of these changes so it is often impossible to give you a guaranteed quote at the time of service. That is why we stress that our treatment plans can only estimate coverage. Most insurance plans base benefits on a schedule of fees (UCR) arbitrarily developed by the insurance companies themselves and not what it actually may cost to complete your work. Insurance companies are not required to share these fee schedules. For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the insurance company and not the actual fee charged by our office. Any quality private practice will bill more than insurance UCR on the majority of procedures.
- There may be a deductible (individual or family) which must be satisfied before insurance will pay for a given procedure.
- Since dental insurance is only meant to assist you, there is usually a calendar year maximum. Your insurance will not pay more than this amount in any given year. If you have seen a specialist or another dentist for care, you probably have used some of your annual benefits. Insurance companies do not notify us of changes like this, they only notify you. It is your responsibility to let us know how much is left in these situations so that we can correctly estimate your insurance.
- Your insurance company uses terms and restrictions like ‘alternate benefits’ or ‘preexisting conditions’ to exclude or downgrade procedures to cheaper substitutes. A common situation is when a carrier will only pay for a silver filling or gold crown. This does not mean that you can not have a tooth-colored alternative. It only means that you will be responsible for the small difference in fees. There are also frequency limits, missing tooth clauses and outright exclusions. It is not possible for us to determine these restrictions for every insurance possibility. Simply put, there are times that your insurance contract will not cover the quality of care you need and deserve.