Insurance and Payment
As part of our commitment to outstanding patient care, we are happy to help our patients maximize their dental insurance benefits. We feel strongly that our doctors, not insurance companies, know best when determining the proper course of treatment for a patient. Therefore, we are not participating practitioners with any insurance companies. However, we can submit insurance claims on behalf of our patients to all insurance companies, with the exception of HMO’s.
If your plan allows you to choose any dentist (i.e. you don’t have to pick from a list), you will receive benefits for treatment in our office. The coverage depends on your particular plan, which is specified in a contract between the insurance company and your employer. Plans vary widely in terms of which procedures are covered and what percentage of the fee is paid.
Some plans allow patients to choose any dentist, but have contracts with “preferred” or participating dentists. Dentists under contract with an insurance company are required to accept the insurance company’s coverage as full payment. Because we do not participate with any insurance companies, our patients are responsible for the difference between what their insurance pays and our fees.
Our computer system will estimate the portion of the fees that are the patient’s responsibility. The estimate is based on coverage information we have in our system from past appointments and/or other patients with the same employer. Incorrect estimates frequently occur because insurance companies change their level of coverage annually and we may not have processed a claim for that particular employer/insurance plan to date. Should a patient overpay based on their estimate, we will gladly refund the over-payment or apply the credit to a future service. In case of an under-payment, we will bill the patient for the difference during our monthly billing process.
All BlueCross BlueShield plans (including BCBS of the Federal Government), Dental Business Operations (an extension of BCBS), Mamsi, Optimum Choice and Delta Dental will NOT pay us directly and instead reimburse the patient. Patients with these types of insurance are responsible for paying their charges in full at the time of service. We do not receive an Explanation of Benefits (EOB) from these carriers.
All other non-HMO insurance companies typically pay us directly and provide us with an EOB. These patients are responsible for their estimated co-payment at the time of service.
When a patient has coverage with both a primary and secondary insurance carrier, we can submit a claim to the secondary carrier with a copy of the Explanation of Benefits (EOB) from the primary. If a patient has primary coverage through a carrier that does not provide us with an EOB, we request that the patient provide us with a copy so that we may submit the secondary claim.