Dental insurance is actually a benefit negotiated by your employer and insurance companies. Usually, these policies will pay a percentage of an arbitrarily set fee for certain procedures. Those arbitrary fees are often called “usual and customary” by the insurance companies that set them. In reality, those fees are usually significantly less than the actual fees of dental practices. Our insurance coordinators deal with many different insurance companies. Some companies offer many different dental and medical plans. These companies can change benefits, co-pays, and deductibles many times throughout the year. We do our best to provide you with accurate coverage estimates based on information available to us. At times, it is almost impossible to accurately estimate a patient’s insurance co-payment. Many insurance companies will not give out fees until after the treatment is completed. Dealing with these companies can be difficult and time consuming. As a courtesy, we ask that you keep us informed of any change to your insurance. It is important that all information about you and your insurance is current.
Although we will gladly file a claim on your behalf, you may wish to submit the claim yourself. In general, insurers process claims filed directly by patients faster than those filed by the service providers (dental offices).
Further, most dental insurance policies are limited and often only pay for a portion of the procedure(s) that may need to be done.
The majority of dental plans reimburse approximately 30-80 percent of treatment costs. With this in mind, we ask that 20 percent of the fee be paid at the time of treatment.
If a patient comes to us with a problem that they expect to be covered by medical insurance (biopsies, tumors, TMJ, infections), they must have a referral from their primary care physician. A referral from a dentist is not adequate for medical insurance coverage. Obtaining a medical referral is the patient’s responsibility. We cannot obtain the referral for you and the referral cannot be obtained retroactively. If you do not have a referral, we will be happy to see you on a cash basis, but your medical insurance company will not pay for your treatment.
Dental procedures are not covered by Medicare.
Private & Group Insurance
As a courtesy to our patients with medical and/or dental benefit plans, we will submit necessary claim forms, receipts, and other information to your insurance company. Ultimately, however, all charges are the responsibility of the patient.
Upon receipt of an insurance payment, any balance due will be billed to you. If you have deposited an excessive co-payment, it will be refunded to you.