Why do you require my picture and social security number?
We take your security seriously and ensure that your information/records are kept safe. At your first visit, you can expect to have a photo taken along with filling out paperwork. By doing so, we can avoid any sort of fraudulent situations.
Is your facility wheelchair accessible?
Yes. Our building is accessible via elevator.
Do you “take” my insurance?
We probably do! Our office is a Preferred Provider (PPO) for United Concordia, MetLife, Blue Cross Blue Shield, Cigna, Delta Dental, Guardian, Cigna, United Healthcare and more. To find out of we take your insurance you can click here to see a full list of insurances we do and do not take or give us a call!
Why aren’t you a preferred provider (PPO) for my insurance?
Unfortunately, some insurance companies do not pay dental providers enough to cover the cost of labor and materials needed for a procedure. Your plan may also be an HMO/DMO plan in which your insurance has a pool of providers already set for you.
What does PPO stand for?
PPO stands for Preferred Provider Organization. This is where a contract is signed between the provider and the insurance to enable the provider to accept a certain fee for services performed. For example, a provider’s cost for a procedure may be $200, however the insurance says it will only pay $150 for it. Providers in-network with PPO accepts the discounted fee so they can be listed as an in-network PPO provider. It’s a win-win for both the patients and the providers. The patients are able to pay at the insurance’s discounted rates while the providers gain the opportunity to acquire new patients.
I have insurance, so why do I have an out-of-pocket expense for my treatment?
Your dental insurance doesn’t necessarily pay for your entire treatment. Typically, dental insurance covers 80%-100% of preventative treatment (cleaning, exam, and x-rays), up to 80% restorative treatment (minor fillings), and up to 50% of major treatment (such as crowns and bridges). Prior to your appointment, our insurance coordinators do their best to estimate your portion of the payment based on the information your insurance gives to us. However, there are hundreds of insurance companies and thousands of individual plans that it’s difficult for us to know them all. We won’t know exactly how much your insurance will cover until we send a claim after the procedure is done.
You told me I owe one amount, now I have a bill for more. I thought my insurance company was supposed to cover this?!
Prior to your appointment, we do our very best to estimate your out-of-pocket cost before you leave our office. Our estimates are based on the information provided by your insurance. However, exact costs cannot be determined until a claim is sent out to the insurance. Here are some reasons why you may have received a bill:
- You have not met your deductible
- Your plan consists of a waiting period and it has not yet been met.
- Your insurance plan paid less than expected for the procedure.
- The treatment was not covered by your plan.
- There was a downgrade in the procedure code because the insurance company found the procedure unnecessary.
- You’ve maxed out your plan (used up all of your benefits) and you no longer have coverage until the new year.
Dealing with insurance can be tricky. But we will try our best to best explain your benefits to you. If you have further questions on how the insurance process goes, please don’t hesitate to give us a call.
How long does it take for an insurance claim to be processed?
It varies. The average time it generally takes to process a claim is at least 2 weeks. If you’d like to have it sooner or complain about a delayed payment, give your state’s insurance commissioner to ensure your insurance company pays within the period allowed by your state law.
The dentist says I need to have a specific procedure done. However, my insurance does not cover this procedure. Why not and isn’t there an alternative procedure that would work the same?
The diagnosis made by your doctor helps determine the right treatment you need and not what your insurance covers. If you’re having trouble paying for treatment, let us know. We offer financing options and depending on the treatment, we can sometimes split the cost based on the number of visits required for the treatment.
Will you change the date or put a different date on my procedure so my insurance company will cover it?
No. We do not tolerate dishonesty in our facility. This would be considered insurance fraud. Our contract with your insurance company ensures accurate and honest information. Dishonesty can lead to our dental license revoked and relationship with PPO to be cancelled. We believe in providing quality care with accuracy and honesty considered.
I want to understand my insurance benefits better. What should I ask my insurance company/plan administrator?
Here are the key things you should ask:
- Plan Year: Does your plan follow a calendar year (Jan 1st – December 31st)? If not, what month does your plan year start and end?
- Waiting Periods: Is there a waiting period for certain procedures? When does the waiting period start and end?
- Age Limitations: What procedures, if any, have age restrictions?
- Yearly Maximum: What is your annual and lifetime maximums? How much have you used and remain
- Frequencies: How often can you receive treatment for a certain procedure? (Cleanings, exams, x-rays, etc.)
- Composite Restorations: Does your plan cover up-to-date composite fillings? Or does it downgrade
- Percent Breakdown of Coverage: What percent does your insurance cover for Preventative/Diagnostic? Basic Restorative? Major Restorative Treatment and Prosthodontics?
When you’ve gathered this information, let us know! It’ll help us further understand your insurance plan and help us estimate your co-pay better.
I have more questions that need answers!
No problem. If it is an insurance question, we will try our best to solve it, however we highly recommend that you contact your insurance company first. Visit their website or schedule a meeting with your human resources department at your job. For anything else, just give us a call. Our phone-lines are open 24/7 and our customer service representatives are available and eager to help you.