If you have dental insurance we will
gladly submit your claim on your behalf. However, we cannot
guarantee any estimated coverage, as the insurance policy is an
agreement between you and your insurance carrier.
No insurance pays 100%
of all procedures. Dental insurance is meant to be an aid
in receiving dental care. Many patients think that their insurance
pays 90-100% of all dental fees. This is not true! Most plans
only pay between 50-80% of the average total fee. Some pay more,
some pay less. The percentage paid is usually determined by how
much you or your employer has paid for coverage or the type of
contract your employer has set up with the insurance company.
Benefits are not
determined by our office. You may have noticed that sometimes
your dental insurer reimburses you or the dentist at a lower rate
than the dentist's actual fee. Frequently, insurance companies
state that the reimbursement was reduced because your dentist's fee
has exceeded the usual, customary, or reasonable fee ("UCR") used by
the company. This can be very misleading and simply is not
accurate.
All of our fees have been accepted by
Delta Dental (considered the standard for dental insurance
companies), as usual and customary. In general, the less expensive
insurance policy will use a lower usual, customary, or reasonable (UCR)
figure.
Your estimated
co-payment is due the day treatment is initiated.
If we have received all of your
insurance information on the day of the appointment, we will be
happy to file your claim for you. You must be familiar with your
insurance benefits, as we will collect from you the estimated amount
insurance is not expected to pay. We will file insurance
electronically so your insurance company will receive each claim
within days of the treatment. By law, your insurance company is
required to pay each claim within 30 days of receipt. You are
responsible for any balance on your account after 30 days, whether
insurance has paid or not. We will promptly send a refund to you if
your insurance pays more than was expected.
Please understand
that we file dental insurance as a courtesy to our patients. We do
not have a contract with your insurance company, only you do. We
are not responsible for how your insurance company handles its
claims or for what benefits they pay on a claim. We can only assist
you in estimating your portion of the cost of treatment. We at no
time guarantee what your insurance will or will not do with each
claim. We also can not be responsible for any errors in filing your
insurance -- once again, we file claims as a courtesy to you.
Most
importantly, please keep us informed of any insurance
changes such as policy name, insurance company address, or a change
of employment.
Does your office
accept my insurance?
-
With an Indemnity Plan patients
can choose their own dentist and their coverage remains the
same.
-
Within the Delta organization we
are a Delta "Premier" provider
-
With a "PPO" plan (Preferred
Provider Option) coverage % is usually higher and deductible
lower at a Preferred Provider. You need to check your
individual plan to verify your options in and out of the
network.
-
We are a Preferred Provider for: Connection Dental
While we do see many Blue
Cross/Blue Shield patients, we are considered an "Out of Network
Provider". Blue Shield requires their patients to pay an out of
network provider the entire fee at the appointment, then Blue
Shield reimburses the patient according to their fee schedule.
-
We are not a provider for any DMO
plans.
-
We are not a Denti-Cal or Healthy
Families provider.
If you have a co-payment due at your
appointment, as an alternative to paying with cash or a check we
accept Visa, MasterCard and Discover cards.
