Questions About Your Insurance

As a part of our service to you we provide many convenient financial options including the courtesy of filing dental insurance claims on your behalf. Please note most insurance plans will not cover 100% of the cost of your treatment. Because of this, you will be asked to pay your deductible as well as your estimated portion of the charges on the day of service. Your insurance policy is a contract between you, your employer, and the insurance company. Our office is not a party to that contract but we will work with you to maximize your insurance reimbursement for covered procedures.

• What is a deductible?
  • A deductible is the amount you pay for a covered service before your insurance plan starts to pay. Please verify with your insurance carrier the deductible amount as this is specific to your individual policy.
• What is an estimated portion of coverage?
  • An estimated portion of coverage is just that- an estimate. While we work on your behalf to estimate dental benefit coverage as close as possible to the correct amount, the precise amount of your financial responsibility is not determined until after the insurance claim has been processed. Our estimations are often close if not exact, however, if there is a difference you are ultimately responsible for any and all charges incurred in our office.
• Why did my insurance pay a different amount than I expected?
  • Your dental benefits may vary for a number of reasons, such as:
    • The treatment rendered is not a covered benefit in your policy
    • You have not met your insurance deductible
    • Your dental benefit has only paid a percentage of the fee
    • You have already met the maximum allowance of benefits in a given time period
    • You have not met the end of your insurance plans waiting period.
• What percent will my insurance plan pay?
  • This question is best answered with a conversation between you and your insurance carrier. We will do our best to explain our understanding of your insurance benefits to you, however, due to provisions in your insurance contract such as: waiting periods, insurance maximums, deductibles, and non-covered services it may be impossible to estimate this precise coverage without a detailed conversation with your insurance provider.
• What is the difference between “In-network” vs. “Out-of-Network”
  • “In-network” means we have agreed to charge a contracted rate for the procedures that your insurance plan will cover. For these covered services, your insurance company will pay a percentage of the contracted rate and you will only be responsible for the remaining percent balance until the entire contracted rate has been paid.
  • “Out-of network” means we do not have a contract with your specific insurance carrier and you are responsible for what is charged. You can still use your insurance benefits and we will work with your insurance to estimate coverage. For any covered services, your insurance company will pay a percentage and you are responsible for any remaining balance your insurance does not cover.
• How long do insurance claims take?
  • The insurance claim will be filed immediately however it often takes up to 30 days for the insurance company to pay your claim. In the event we do not receive payment from your insurance carrier within 60 days, the entire balance is due from the insured and/or the patient. You will be responsible for any amounts in which your insurance company does not pay, for whatever reasons. In the event of a dispute for insurance payments, it is best to contact your employer or insurance company directly. We will provide all necessary information to help you dispute your claim.