Paying for Great Dental Care
We understand that good dentistry can be an expensive proposition. Because of this, our team works very hard to help you afford the dental care you deserve.
- Whenever feasible, we will try to provide several treatment options – an ideal option along with one that may have some compromises to be more economical.
- We will let you know the total anticipated cost of your treatment before we begin with a written estimate.
- We will offer you the choice of several payment arrangements. Our options are continually changing as we find partners to work with that offer competitive interest rates and more flexible terms. Our financial coordinators will do their best to find a comfortable payment option for you.
- We will outline your financial responsibilities before beginning your treatment to eliminate surprises.
Using Your Dental Insurance
Dental insurance is kind of like that drunk uncle that says he’s paying for dinner and then tells you he forgot his wallet once the bill comes. While having insurance can be a good thing, don’t count on it to pay the bill.
If you are lucky enough to have dental coverage, we’ll assist you in maximizing your benefits by completing your claim forms for you. We will bill your primary insurance as a courtesy to you and we will do everything we can to help you get your benefits. In the meantime, we extend credit for up to 90 days for the remainder expected from your insurance company.
- If you assign your insurance benefits to our office, we will initially ask you only for your estimated deposit. Please understand that this is only an estimate, and is based upon the information available to us.
- If you do not elect to have your benefits paid directly (assigned) to our office, or if your carrier does not allow assignment of benefits, you will be responsible for the full amount due at time of service. We will file your insurance and direct the reimbursement checks directly to you.
- We will process all private care or PPO insurance plans (plans that allow you to select an ‘in-network’ or ‘out-of-network’ dentist). This means that you can use your benefits from literally thousands of companies.
Your benefits depend Solely on What Plan Was Purchased.
Your plan will likely have pages and pages of rules like deductibles, downgrades, maximums, alternate benefits, preexisting conditions, frequency limitations and arbitrary Usual Customary and Reasonable (UCR) tables. Some plans cover as little as 30% or as much as 100% of dental services, with most falling in the 40% to 60% range.
We will try our best to help you get an accurate estimate from your insurance company. Most carriers make this virtually impossible since there are no “standard” rules. We encourage you to verify your coverage directly with your insurance company if you have additional questions or concerns. In some cases, you may wish to obtain a written preauthorization for your treatment plan. You should know that your insurance company may take up to three months to give you an answer and their answer will be non-binding.
What Should I Do With My DMO Coverage?
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.
How Can I Pay My Bill?
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.
Why Have I Received an EOB and a Delinquent Account Notice Simultaneously?
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.
What Happens if I End Up With a Credit On My Account?
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.
What Is an EOB and How Do I Read It?
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.
What Is My Responsibility if My Insurance Does Not Pay the Claim?
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.
What Can I Do if I Feel My Insurance Company Made a Mistake?
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.
Why Did I Get a Statement if I Have Insurance?
- 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.