COLLECTION FEES:
We aspire to provide the finest care at the most reasonable cost to our patients. It is our goal to communicate clearly with you from start to finish so that your total experience at our office is a good one. This service is based on a friendly, mutual but business-like understanding between doctor and patient. It is also felt that misunderstandings can be minimized if firm financial policies are agreed upon at the beginning of treatment. The following statements are made to acquaint you with our financial policy:
If you have dental insurance:
We do require an estimated payment based on what your insurance company may cover. This payment does not absolve the patient responsibility for the balance owed, after insurance has paid its portion. Acceptance of insurance assignments by this office does not absolve the patient of full responsibility for our charges for treatment rendered. The estimated payment provided by this office is to be considered a guideline until the final insurance payment is received and the patient’s account has been reconciled.
If you do not have dental insurance:
Because of the nature of referral work and the high cost of extending credit, we must respectfully request that all patient balances be paid at the time of actual treatment. If you are unable to pay for treatment upon completion, please advise us now. We realize that this can be a problem for some of our patients, if you need extended period of time to make payments, we will be glad to accept Visa, Mastercard, Discover, American Express or Care Credit.
CareCredit is a credit line for dental expenses. It allows you start treatment immediately and pay over time with low minimum monthly payments. CareCredit offers 12 month No interest payment plans.
You may contact our office prior to your appointment with questions regarding cost. Our office also has included some FAQs about dental insurance. If you do not find your answer here, contact our office and our experienced staff will work hard to answer any financial inquiries.
1. What is a “UCR” and how is it determined?
“UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
2. Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
• You have already used some or all of the benefits available from your dental insurance.
• Your insurance plan paid only a percentage of the fee charged by your endodontist.
• The treatment you needed was not a covered benefit.
• You have not yet met your deductible.
• You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
3. Why isn’t the recommended treatment a covered benefit?
Your endodontist diagnoses and provides treatment based on his or her professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
4. How do I know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance check has been received by your endodontist.
5. How do I understand my Explanation of Benefits (EOB)?
Your Explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan. The statement includes the following information: UCR, copayment amount/patient portion, remaining benefits, deductible and benefit paid.
6. How long does it take for a claim to be paid?
The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.
7. Will my endodontist take my insurance?
Most endodontists fall in one or more categories, and there may be more options than are described here. Some endodontists sign contracts with dental insurance carriers and agree to accept or “take” the payment offered by the insurance company as payment in full, even though it may not be the same amount as the endodontist charges for the procedure. These endodontists are Participating Providers in your plan.
Other endodontists do not sign contracts with dental insurance carriers but may still accept or “take” insurance company payments. These endodontists are not contractually obligated to accept your insurance carrier’s payment as full compensation and are not Participating Providers. In this instance, you may be responsible for a payment portion over and above the percentage provided by your insurance company.
Still other endodontists are not Participating Providers and do not accept payments directly from your insurance carrier. In this case, your endodontist will ask that you be responsible for the entire fee but will assist you in filing your claim to receive insurance benefits directly from your insurance carrier.
8. What if I still have questions?
Our staff will do their best to answer all of your insurance questions. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits.