Questions and Answers about your insurance coverage
As a service to our patients, we will bill your insurance carrier, provided proper paperwork is provided to us. We will also assist you in billing your secondary insurance carrier, if applicable. Payments are due at the time of service; the ultimate responsibility for any unpaid balance rests on you. Please understand that insurance is a contract between you and your insurance company, we are not contracted with medical/dental insurance policies. If an insurance carrier has not paid within 60 days of billing, any unpaid professional fees are due and payable in full from you.
Will my insurance company pay all my medical bills?
Not always. The fact is that most insurance, whether it is medical, theft, fire, or life, merely helps the purchaser meet the expense of some need or misfortune. Life insurance will not support the surviving beneficiary for the rest of his/her life. It’s the same with medical insurance, which is usually designed to help you meet medical bills – not to pay 100% of them. The range of benefits depends on the type of plan you have. Some plans exclude certain types of services such as anesthesia charges or “simple” extractions while other plans cover a full range of services. Some plans may cover as little as 30% or as much as 100% of services, with most falling in the 50-80% range.
What does it mean when my insurance company says the charges are over the “usual & customary?”
You may receive a communication from your insurance carrier suggesting that our fees were over and above the “usual and customary” rate for the services provided to you. Insurance companies base the amount of benefit on a chart or schedule of fees arbitrarily developed by them. How they determine the amount of benefit is a mystery to both the dental and medical professions, since they will not reveal this information. It should be pointed out that insurance companies make no fee allowances for the fact that your treatment is performed by a specialist. The fees paid by insurance companies are based solely on general dental and medical fees. An explanation of what goes into determining our fees is available for you.
Why don’t all doctors charge the same?
Doctors’ fees vary for many reasons. A specialist, who sees fewer patients because more time must be spent with each one, and who has put in extra years of advanced study and spent more for scientific equipment, will normally charge higher fees. Our fees are based on the overhead involved in this practice, the treatment plan selected and the time it takes to provide you with superior care, and are in line with fees charged by the majority of offices with our training and experience. The type of treatment you need and receive from us is based upon our professional judgment and not on whether you are covered by an insurance plan. In addition, the fees are the same, whether or not a patient has insurance.
What can I do if I am not pleased with my insurance benefits?
If, after completion of your care and payment by your insurance carrier, you believe that the benefits provided by your plan were inadequate, you may want to discuss the matter with your employer, union, or association so that appropriate alternatives can be investigated.