Our office currently participates with a select group of medical and dental insurers. If you are insured by one of these companies, you will only be liable for your unmet annual deductible, co-payments, and uncovered procedures or, depending on the policy, a “preferred fee”. These payments are also due at the time services are provided. Our office staff will be glad to answer any questions regarding your specific coverage as it relates to our office payment procedures.
We will gladly discuss your proposed treatment and answer any questions relating to your insurance. At your request, we can obtain a pre-determination of benefits from your insurance carrier. You must realize, however, that:
- Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract.
- Our fees are generally considered to fall within the acceptable range by most companies, and therefore, are covered up to the maximum allowance determined by each carrier. This applies only to companies who pay a percentage of “UCR” (ie, 50%, 80%). “UCR” is defined as the usual, customary and reasonable fee for a particular region. This statement does not apply to companies who reimburse based on an arbitrary “schedule” of fees which bears no relationship to the current standard and cost of care in this area.
- Not all services are a covered benefit in all contracts. Some insurance companies exclude various services. Some may be reimbursed on your major medical policy.
- In order for our staff to best advise you on your insurance coverage and your financial responsibility and to allow for efficient claims submissions, it is imperative that you bring your insurance identification cards with you at the time of your first appointment.
- Please be advised that some managed care medical and dental plans require referrals from a primary care physician. Consult your plan benefits booklet to determine if this applies or check with our staff when scheduling your appointment.
We must emphasize that as health care providers our relationship is with you, not your insurance company. While aid in filing insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date the services are rendered. We realize that in some cases temporary financial problems may affect timely payment of your account. If such problems do arise, we encourage you to contact us promptly for assistance in the management of your account.
If you have any questions about the above information or any uncertainty regarding insurance coverage visit our Insurance FAQ page. Otherwise, please don’t hesitate to call and discuss your options with us. We are here to help you..
To Our Valued Patients with Delta Dental Insurance
Dr. Bunel explains some changes regarding coverage for our patients with Delta Dental.
Insurance FAQs
Many patients have questions about their dental insurance coverage. At Oral and Facial Surgery of Northeast Texas, we are committed to educating patients on how to navigate dental insurance. Our staff is ready and happy to assist you in navigating your insurance coverage and other payment options. For questions about dental insurance, read the FAQ below and call our office to speak with a team member.
Are you in my network? If not, why would my dentist refer me to your office?
Your dentist referred you to our office because we provide the best possible care. But your dentist probably is not informed as to the network participation of our office. All your dentist wants is to refer you to the best oral and maxillofacial surgeon.
If you want to determine whether our office is in your network, call our office to speak with a team member. By sharing your insurance information with our office team, we can quickly determine whether we are in your network.
Why do I have to pay anything if my insurance pays $1,500 annually?
It might seem counterintuitive, but your dental insurance is not meant to pay the entire cost of dental treatments. Your insurance plan has deductibles and copays that come out of your pocket at the time of the procedure. You have to meet your insurance plan’s deductible before any coverage kicks in, and some procedures are not covered at all. You might also have fewer benefits if your insurance covers other dental expenses in the same period.
If I have two insurance policies, why do I have to pay anything out of pocket?
If you have two dental insurance policies, the benefits are coordinated, and secondary benefits are very unpredictable. After the primary claim is filed and paid, the secondary insurance claim will include the benefits information paid by the primary plan. Secondary insurance companies often avoid paying out any benefits at all.
For the sake of prudence, our offices estimate insurance benefits and copays without considering a patient’s secondary insurance plan. If a secondary insurer pays out on a benefit that creates a credit balance on a patient’s account, our office will issue a refund to the patient or responsible party.
Why doesn’t your office estimate a benefit for anesthesia services or implant-related treatment?
Many insurance plans do not provide coverage for anesthesia services and implant-related treatments. Insurance plans often include stipulations your case must meet before benefits are paid for anesthesia and implant services. The specific stipulations vary with each insurance company and can change without notice, making predicting these benefits challenging. So, our office estimates the cost of copays and benefits as if your insurance company will provide no coverage. If your claim results in benefits that create a credit balance, we will issue a refund to the appropriate party.
When will I receive my refund?
Insurance companies often take weeks to send payments to our office. Once the payment is received on our end, the turnaround time is much quicker for you to receive your refund. Our office issues refunds for accounts with a credit balance three times a month.
Most patients receive a notice from their insurance company a week or two before our office receives payment. Once payment arrives, it is credited to the patient’s account. If the payment creates a credit balance on your account, we will issue a refund the same way the original payment was received. For example, if you paid for the procedure with your credit card, your credit balance will be issued back to your credit card.
Why doesn’t your office accept or file with Medicare?
Our primary focus is on providing the best care possible to our patients. We are not Medicare providers because it does not cover many dental services and procedures. By opting out of Medicare, our office is legally forbidden to file claims to Medicare. Patients cannot submit claims to Medicare for services received from our offices.
Do you have other questions regarding your dental insurance or coverage for an upcoming procedure? At Oral and Facial Surgery of Northeast Texas, our team is here to help you cover the cost of treatment. Call our office to discuss your dental insurance benefits with a team member.