Insurance we Accept
We are a “network” provider for the following insurance companies below. Co-pays and deductibles will be collected at time of check-in. Please note that, ultimately you are responsible for knowing what your benefits are and we encourage you to contact your carrier before scheduling treatment. Please remember that you are responsible for your child’s bill, not the insurance company.
INSURANCE CARRIERS WE ACCEPT:
- SOONERCARE
- CIGNA – HMO
- CIGNA - PPO
- AETNA
- AMERITAS
- BLUE CROSS BLUE SHIELD - We Accept all of them including Federal Employee Program
- CAREINGTON
- CONNECTION-GEHA
- DELTA DENTAL
- DENTAL NETWORK OF AMERICA
- DENTEGRA
- DENTEMAX
- DHA ASSURANT (SunLife)
- GUARDIAN
- HEALTH CHOICE
- HUMANA
- METLIFE
- PRINCIPAL
- TRICARE
- UNICARE
- UNITED CONCORDIA
- UNITED HEALTHCARE
For the insurance companies which we are not in Network with, we will closely work with you and file the insurance claims in order to ensure that your child receives the optimal treatment he/she deserves.
Insurance Policies
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. By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid for it or not. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until the outstanding balance is paid. We will be glad to send a refund to you if your insurance pays us.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company. 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 do not guarantee what your insurance will or will not do with each claim. We are not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.
Fact 1 - 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 your insurance company.
Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
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.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees they consider reasonable. These reasonable fees may vary, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. Frequently, this data can be three to five years old and these fees are set by the insurance company so they can net a 20-30% profit.
Unfortunately, insurance companies imply that your dentist is overcharging, rather than say that they are underpaying, or that their benefits are low. In general, the less expensive insurance policy will use a lower reasonable (UCR) figure.
Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume a service fee is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible averages $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00, or your plan pays only at 50%, then the insurance benefits will also be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
Claim Processing
We are pleased to offer electronic billing to our families with dental insurance. With your complete subscriber information, we can electronically bill the primary insurance carrier the same day as services are rendered. In order to successfully process a claim, the following information is necessary:
- Subscriber’s Name
- Address
- Birthdate
- Social Security Number
- Employer
- Insurance Company’s Name & Address
- Insurance card
Preauthorization
If we receive all of your child's insurance information on the day of the hygiene visit, we can preauthorize the recommend treatment plan. It takes at least 20 to 30 days to receive a preauthorization back, even though we file everything electronically. When we know what your insurance will pay, we are able to break down payments per visit. If there is a change in what the insurance company pays, you will be billed within days of our receiving payment. You are responsible for all amounts not paid by insurance.