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Office Policy Regarding Dental Insurance
If we have received all of your insurance
information on the day of your appointment, we
will be happy to file your claim for you. If you
are not familiar with your insurance carrier's
benefits, we will try and help you as much as we
can. At the time of treatment, we will collect
from the patient the estimated amount that
insurance is not expected to pay. By law, the
patient's insurance carrier is required to pay
each claim within 30 days of receipt. We file
insurance claims electronically so that the
patient's insurance carrier will receive each
claim within days of the treatment. The patient
is responsible for any open balance on account
after 90 days, whether insurance has paid or not
and at that time we will have you contact the
insurance carrier to accelerate the payment
process.
Please understand that we file dental insurance
as a courtesy to our patients. We do not have a
contract with any insurance carrier - only the
patient does. We are not responsible for the way
that insurance company handles its claims, or
for what benefits they pay on a claim. We can
assist patients in estimating the patient's
out-of-pocket portion of the cost per treatment
but we will at no time guarantee what insurance
will or will not do with each claim.
Dental Insurance Facts
Dental insurance are structured by percentages
and do not typically have co-payments. Preventive
treatments (cleanings, exams and x-rays) are
usually paid at 100% of usual and
customary. Basic treatments (fillings,
root canals, etc.) are usually paid at 80%
of usual and customary after you pay your yearly
deductible. Major treatments (crowns,
bridges, partials, dentures, etc.) are usually
paid at 50% of usual and customary after
the patients pay any required annual deductible.
Deductibles. There is usually a maximum
deductible per year.
The dental
deductible applies to each covered person for
each benefit period. It refers to the amount of
eligible expense a person must incur during the
benefit period
(which can be a calendar year or a fiscal year
depending on the carrier)
for dental care
before receiving reimbursement for services.
Some insurance policies have a missing tooth
clause that states that if a patient has a
missing tooth before becoming insured through
their plan then they will not pay to have
the tooth replaced.
Some policies have a replacement clause
that states that if the patient needs a crown or
bridge (or similar) replaced, then they will
only pay the plan allowed portion if it has
been over 5 to 10 years since the initial
procedure. The replacement clause is differs
from plan to plan.
Patient or policy holders who have questions or
concerns regarding dental insurance claims or
typical carrier policies, should contact Kim
Cochran in our office. Kim has over 25 years of
experience with filing dental claims and working
with dental insurance companies and is happy to
assist. |
