Insurance
What is our Insurance Policy?
As a service to our patients, our practice accepts most dental insurance programs. Our staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit, at your request, a pre-treatment estimate to your insurance company so that you will be acquainted know what your benefits may be. We can help you understand but not guarantee your coverage. Please understand that insurance companies make their profit by NOT PAYING OUT through many fine print rules and regulations that only the patient has access to.
The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that even the same insurance company may vary greatly in the level of coverage available. Also, some companies take care of claims promptly while others delay payment for weeks or even months.
What is our Financial Policy?
We strive to deliver the finest care at the most reasonable cost to our patients. For your convenience, we accept cash, cheque, Debit, Visa and MasterCard. Payment plans are by request only and should be discussed with a member of our business staff prior to treatment.
In our office, we deal with over 70 different companies that underwrite dental insurance. Each company has multiple combinations of plans and options, some of which are selected by the patient and some of which are decided by the employer.
Additionally, the plans change from time to time, certainly without notice to us, and often without notice to the subscriber (the patient). Patient needs vary greatly. As with any form of insurance, the extent of coverage is usually a business decision based on cost control. The needs of the patient and good clinical practice may become secondary considerations. We offer the following comments:
Our recommendation reflects your needs and the requirements of good health oriented dental practice. Our treatment recommendations may or may not be covered by your insurance contract.
We can identify short-term and long-terms goals in our treatment objectives so as to plan treatment in phases. Where alternatives exist, we will be happy to discuss them with you. Flexible payment plans are available to accommodate most budgets.
We will accept assignment of insurance benefits as a convenience to our patients. It is done on the trust and understanding that all amounts paid by the carrier will be promptly remitted to us, and that any deductible or patient's portion will be promptly paid. This acceptance of assignment is a privilege, not a right.
Most benefit plans have guidelines, such as fee schedules, that specify the maximum amount they will consider reimbursing for a procedure, service, or a group of procedures or services. This amount is called the eligible amount. In addition, benefit plans usually specify the percentage of eligible amount that will be paid.
Coordination of benefits is a process that allows eligible individuals, couples or families with more than one benefit plan to combine their benefits coverage to receive up to the maximum eligible amount in accordance with the contract provisions. If you or your eligible dependents have coverage through another benefit carrier, we will submit the statement as part of a claim to your other benefit carrier for coordination of benefits. If your other benefit plan has already paid for part of your claim, the amount covered will be indicated in the other plan paid column.
A benefit plan may have a maximum amount that it will pay for a procedure, service, or group of procedures or services. The patient is responsible for the remaining amount.
The insurance claim must accurately and fairly describe what procedures were rendered for each patient. The date of treatment must be accurate and cannot be changed in order to receive insurance coverage.
Although we make every effort to advise you of your contract benefits, we cannot guarantee that your insurance carrier will pay for the treatment. Even a predetermination of eligibility in not an ironclad assurance that the insurance company will pay what they have "threatened" to pay. In the event of non-payment of a claim by an insurance company, it is the responsibility of the patient to pay for the treatment that he or she has received.
In those situations where coverage is open to interpretation, the patient is more likely to get a more favorable hearing by discussing the matter personally with the group administrator and/or the claim adjudicator rather than having us make a third-party submission on their behalf. It is the squeaky wheel that gets the grease, and patients have to be their own advocates.
Please let us know if there is anything that we can do to help. We are here for you, and want to work with you in achieving and maintaining good dental health.