How Insurance Works
Insurance has two major benefits for the patient: a discounted price on services (resulting in a lower out of pocket), as well as offering to cover a portion of the cost of services rendered. The way our estimations work are based on your insurance’s in-network discounted fees. So those are a fixed cost for you, but they can vary each year based on our negotiations with your provider, which may account for different quotes over a number of years. And every insurance company sets their own fees, so if you change insurance companies, the prices will change.
Your out-of-pocket responsibilities can vary according to your annual deductible, your annual maximum, and how much of that maximum you have left for the current plan year. This affects how much insurance will pay for your procedures.
How We Can Help You
Initial Verification: We want to make things as easy as possible for you to enjoy your trip to the dentist, so we try our best to understand your insurance coverage before your visit with us. We ask that you fill out your forms beforehand so that we can verify your insurance & benefits before your visit. This can help cut down on wait times when you arrive.
Before your appointment, we speak to an insurance representative to understand the following:
1) Your annual maximums & deductibles
2) Your coverage percentages for Diagnostic & Preventive, Restorative, Periodontal, Endodontic, Oral Surgery, Crowns, and Orthodontic services
3) Allowable frequencies
We then apply your carrier’s discounted fees to the treatment plan, which updates the total cost & estimated coverage percentages.
Claim Submission: After we submit claims to your insurance carrier, we work with them to provide more information, x-rays, and narratives to ensure the best possibility of pay-out. If we receive denials of coverage for services that weren’t due to frequency, annual maximums, or non-covered services, we will send an appeal on your behalf to encourage their payout. We fight to get you as much as coverage by your insurance as possible.
However, if insurance continues to deny our appeals, the balance on the account is the responsibility of the patient.
We ask that as soon as your updated insurance information is available, you pass it along to us so we can update your treatment fees (which affects your estimations). A phone call is the quickest way to get the information to us, but please feel free to email it to us using the contact form. The following information is usually required to verify your insurance:
- Insurance Carrier:
- Subscriber’s Name:
- Subscriber’s Date of Birth:
- Relationship to Subscriber:
- Member/Subscriber ID/SSN:
- Group # (if Known):
Ultimately, as the policy holder, you are responsible for understanding your coverage and limitations. As the person who pays them, insurance companies will often give you more thorough information.
We accept most dental insurance PPO plans for your convenience and offer financing options through CareCredit to make getting your necessary dental treatment convenient.