Insurance Processing

If you are lucky enough to have dental coverage, it is our pleasure to assist you in maximizing your insurance benefits by completing your claim forms for you. We will bill your insurance as a courtesy and do everything we can to help you get your benefits. In the meantime, we can extend credit to you for the remainder expected from your insurance company.

• If you assign your insurance benefits to our office, we will initially ask you only for your estimated deposit. Please understand that this is only an estimate, and is based upon the information available to us.
• If you do not elect to have your benefits paid directly (assigned) to our office, you will be responsible for the full amount due at time of service. We will file your insurance and direct the reimbursement checks directly to you.
• We are preferred providers for Delta Dental Premier, Delta Preferred and Metlife PPO.
• We currently accept and will process all private care or PPO insurance plans (plans that allow you to select an 'in-network' or 'out-of-network' dentist). This means that you can use your benefits from literally thousands of companies.The range of benefits depends solely on what your employer wishes to purchase. Some plans cover as little as 30% or as much as 100% of dental services, with most falling in the 40% to 60% range.

Why would I get a bill after my claim is processed?

1. Although we do maintain computerized histories of payment by a given company, they change often. Insurance companies are not required to notify us of these changes so it is often impossible to give you a guaranteed quote at the time of service.
2. Most plans base benefits on a schedule of fees (UCR) arbitrarily developed by insurance companies and not what it actually may cost to complete your work. For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if your plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the insurance company and not the actual fee charged by our office. Any quality private practice will bill more than insurance UCR on the majority of procedures.
3. There is a deductible (individual or family) which must be satisfied before insurance will pay for a given procedure.
4. Since dental insurance is only meant to assist you, there is a calender year maximum. Your insurance will not pay more than this amount in any given year. If you have seen a specialist or another dentist for care, you probably have used some of your annual benefits. Insurance companies do not notify us of changes like this, they only notify you. It is your responsibility to let us know how much is left in these situations so that we can correctly estimate your insurance.
5. Lastly, your insurance company uses terms and restrictions like 'alternate benefits' or 'preexisting conditions' to exclude or downgrade procedures to cheaper substitutes. A common situation is when a carrier will only pay for a silver filling or gold crown. This does not mean that you can not have a tooth-colored alternative. It only means that you will be responsible for the small difference in fees. There are also frequency limits, missing tooth clauses and outright exclusions. It is not possible for us to determine these restrictions for every insurance possibility. Simply put, there are times that your insurance contract will not cover the quality of care you need and deserve.

What is my responsibility if my insurance does not pay the claim?
The financial obligation for your dental treatment is yours. The insurance company is responsible to you, and not to our office. We will assist you in any way that we can, but please know that we do not work for any insurance company and therefore cannot guarantee their payment. Once your carrier has paid the claim, any difference will be due upon receipt of our statement. If, for any reason, we have not received your insurance carrier's payment within 90 days after submitting the claim, the remaining balance will be due and payable by you. Balances over 90 days old are subject to 18% APR.