INSURANCE REIMBURSEMENT
If you have dental insurance, our insurance coordinator will work with you to maximize your insurance reimbursement for covered procedures. As a service to you, we will confirm your eligibility, discover the amount your insurance is estimated to pay, and file your insurance claim. Any amount that is estimated to not be covered by your insurance is to be paid by you in full at the time services are rendered. Since insurance companies do not guarantee the accuracy of the estimates they provide, we cannot guarantee their estimate and you should consider their estimate as only a guideline until the final insurance payment is received. You are responsible to pay any difference between the insurance payment and the fee for services rendered.
CONTRACTED INSURANCE COMPANIES
We will provide the root canal services for a patient insured by ANY insurance company. Even if we are not contracted with your specific dental plan, we are still able to maximize any out of network benefits you may have available under your plan. Because we have contracted agreements with the companies below, additional savings may accrue to patients insured by the following insurance carriers:
UNDERSTANDING DENTAL INSURANCE BENEFITS
Because most insurance plans are different from one another, it is important that you understand your specific dental insurance plan and the benefits that it provides for endodontic care. If you have any insurance questions, please call our office and speak with our insurance coordinator. She will gladly help with any questions related to your insurance benefits at our office.
WHAT IS “UCR" OR THE ALLOWABLE MAXIMUM?
UCR and allowable maximum are terms used by insurance companies to describe the amount they are willing to pay for a particular procedure. There is no standard fee or an accepted method for determining UCRs or maximum allowable fees. The UCR has no relationship to the fee charged by dental offices and is set by individual insurance companies based on their calculations to profitably administer their dental benefit plans.
WHAT WILL INSURANCE PAY?
The amount insurance plans pay varies according to many factors such as your annual maximum benefit, benefit used to date, your deductible, and services covered or excluded by the plan. Therefore the amount that will actually be paid by the insurance company will often not be known until the insurance company releases its Explanation of Benefits. It’s anyone’s guess as to why insurance companies are like this – we call it insurance Voodoo.
WHY MIGHT THE TREATMENT NOT BE A COVERED BENEFIT?
We diagnose and provide treatment based on your specific health needs, not on the benefits covered by insurance plans or on the cost of treatment. Some employers and/or insurance plans exclude or disallow coverage for necessary treatment as a way to reduce their costs. Your plan may exclude certain procedures, although they were deemed necessary for the proper diagnosis and treatment of your condition.
HOW LONG DOES IT TAKE FOR MY INSURANCE COMPANY TO ISSUE PAYMENT?
Again this varies, but at least 38 states have passed laws that require dental insurance carriers to pay claims within a period ranging generally from 15 to 60 days. If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. The insurance commissioner wants to know if your insurance company does not pay within the period specified by state law. You may find the names and addresses of insurance commissioners by following this link: www.naic.org/state_web_map.htm.
Our office manager will work with your patients to maximize insurance reimbursement for covered procedures. We will confirm patient eligibility, discover the amount insurance is estimated to pay, and file the insurance claim. We will provide the services described above for a patient insured by any insurance company. Because we have contracted agreements with the companies below, additional savings may accrue to patients insured by the following insurance carriers:
- Delta Dental
- Advantage Dental
- Cigna Dental Network Savings Program
- MetLife
- Aetna
