Frequently Asked Questions
Why am I receiving a bill?
We send out statements to patients whose services have not been paid for in full. This can be from a combination of your co-payments and insurance payments. We do our best to estimate your out of pocket expenses at the time services are rendered using the information provided by your insurance company. However, there are many factors that may change the outcome of a claim once it is submitted to your insurance company for processing, and they may be specific to your individual insurance plan.
Contact your insurance company with any questions as to why they may have paid less for your claim before contacting our billing department, as they can provide clarification regarding allowed amounts, frequency limitations and calendar year maximums.
I was in your office several months ago. Why am I receiving a bill now?
Claim processing times can vary depending on what insurance company you have. The average claim processing time is 4-6 weeks. If additional information is needed to process the claim, or if we are submitting an appeal on your behalf, it could take longer.
I’ve been told that I need services that my insurance company doesn’t cover. Should I still get them done?
It’s important to remember that your dental insurance company isn’t designed or operated by dentists. Dental insurance is designed to supplement your out of pocket costs for your dental services, not cover
them at 100%. With that being said, if your doctor is recommending any treatment to you, they are doing so based on your dental needs, and not the treatment’s associated cost. So, if your insurance doesn’t cover a dental procedure at 100%, or even at all, it does not mean it is unnecessary.
My insurance company has denied my claim. I cannot afford the balance. What are my options?
While we do our best to help patients plan ahead for their anticipated out of pocket costs, they sometimes end up greater than expected due to claim denials. Our office will make every attempt possible to work with your insurance company to maximize your benefits and reduce your out of pocket costs, such as submitting appeals or additional documentation. In the event that we are unsuccessful, we do have financial options that might alleviate some of the financial stress that unforeseen balances might cause. Care Credit and Lending Club are great options for out of pocket
medical expenses. You can apply online or in our office. If you have any questions, one of our experienced financial coordinators can help you find a payment option that works best for your financial situation.
I’m not sure I want to commit to treatment in the event that my insurance doesn’t cover it. What should I do?
The best way to determine what an insurance company is going to pay for treatment, is to submit what’s called a Pre-Determination. This is very similar to submitting a claim to your dental insurance company, but it is done so before the services are rendered. Your insurance company will process the claim the same way they would if you had gotten the services done, but they do not issue any payment. You can expect this process to take just as long as the processing of a claim, which is about 4-6 weeks.
However, having a Pre-Determination on file does not guarantee payment. Furthermore, it’s important to remember that this time-frame may not be suitable for emergency care, and your dental health may suffer if you choose to postpone treatment while awaiting the results of a Pre-Determination.