Financing Your Care
Our practice philosophy is based on quality service for our patients and we are committed to providing the highest quality of endodontic treatment. It is important to our professional relationship that you have a clear understanding of our Financial Policy, Fees and Insurance. We are available at any time to discuss your proposed treatment and answer any questions.
Dental insurance is a highly complex area that creates confusion for dental patients. The complexities of dental insurance and the lack of sufficient information make it almost impossible for some patients to properly understand what their employer and the insurance company have negotiated for your benefit package and stipulations. It is a contract between your employer and the insurance company. Oconee Endodontics is not involved in the agreement terms of your policy. However, our office will submit your claims to assist you in achieving the maximum reimbursement to which you are entitled. It is the patient’s responsibility to contact their individual insurance carrier in order to discuss and understand the extent and limitations of your coverage.
We are in-network provider with
the following insurers:
1) Delta Dental
2) Cigna (Radius Plan)
3) Aetna (which may include Ameritas, Standard Reliance, Physicians Mutual, and Principal)
Be aware that our office does not participate in all dental plans even though your referring dentist may participate and has referred you to our office for endodontic treatment. If you are a member of a PPO, HMO, Discount Dental Plan, Direct Reimbursement Plan or a dental plan that does not accept assignment of benefits to this office, payment is expected at the time service is rendered.
Our office is not a provider for Medicaid or Medicare and cannot file this for you
Please note: Payment is due at the time of service.
- Cash: Discount for paying full amount in cash
- Check or Credit Card (Amex, Visa, Master Card, Discover)
- CareCredit: Apply online (www.carecredit.com) or in our office.
As a courtesy to you, we will bill your insurance company and track claims. Please keep us informed of any changes to your insurance plan. You are responsible for the fees charged by our office, no matter what your insurance coverage may be. Most insurance companies should respond to the claim within four to six weeks, but it may take longer to get a claim resolved. We will do all that we can to get your claim paid expeditiously. After all claims have been paid by the insurance company, any remaining cost is your responsibility.
- My insurance sent me a note saying they paid. When do I get my refund?
It’s not unusual for the insurance company to indicate they have paid us via a note sent to you. Often though, the check is not printed and mailed for up to 2 weeks after the notice is printed and sent. It may even take up to 30 days after the note from the insurance company before we actually receive the check.
Upon receiving and posting the insurance payment, if a credit exists a prompt refund will be issued.
- Why doesn’t my insurance cover the cost of my dental treatment?
Dental insurance really is not insurance (as defined traditionally to cover the cost of a loss) at all. It actually is a benefit, usually provided by an employer, that helps employees pay for routine dental treatment. The employer buys the plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are designed to cover a portion of the total cost of treatment, not all of it.
- My plan says that my exams and other procedures are covered 100% and you say it isn’t. What gives?
That’s probably one of the best marketing hypes of dental insurance. They claim to pay 100% or 80% or 50%. The question is 100% of what? The common misconception is that it’s related to our fee and that is just not true. It’s based what your insurance carrier allows and that is related to how much your employer pays the insurance company.
- I received an Explanation of Benefits from my insurance carrier that says my dental bill exceeded the “usual and customary”. Does this mean that you’re charging too much?
Many carriers refer to their allowed payments as UCR, which stands for “Usual, Customary, and Reasonable”. However, this does NOT mean exactly what it seems. UCR is actually a negotiated list between your employer and the insurance carrier for a given procedure based on a variety of variables. The payment listing is related to cost of the premiums and the geographical area where the work is done. In almost all cases, the payment for the billed services is usually less, frequently much less, then what we charge. (See below for a further explanation of UCR.)
Our objective is to provide high-quality dental care at a fair fee while the insurance company’s primary objective is to earn a profit for its shareholders. Yes, we are in business to earn a profit too, but we do not allow the insurance company to dictate the standard and quality of care delivered to you. Unfortunately, our office has been caught in the middle between the insurance company and our patients. In an effort to maintain a high quality of care, we like to share some information about dental insurance with our patients.
A common point of confusion is about how an insurance company determines UCR. Inflammatory information is often sent by the insurance companies which may state our fees are higher than usual and customary. An insurance company surveys a geographic area, calculates an average fee, takes 80% of that fee and considers it customary. Included in this survey are discount dental clinics and managed care facilities, which bring down the average. Many plans tell their participants that they will be covered “up to 80 percent or up to 100 percent,” but do not clearly specify plan fee-schedule allowances, annual maximums or limitations. In fact, “80% of UCR” many times is not even calculated by the fees in the area but instead is some arbitrary number so the company can sell the plan to your employer at a specific cost per person. Hence, it may not represent a practical fee for a given procedure. It is more realistic to expect dental insurance to cover 35 – 65% of major services. Remember, the amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer put in, less the profits of the insurance company. Dental benefits differ greatly from general health insurance benefits – it is never a pay-all, only an aid or supplement. As an illustration, in 1971, the average dental-insurance benefits were approximately $1,000 per year. Figuring a 6% rate of inflation per year, you should now be receiving more than $4,549 per year in dental benefits. Your premiums have increased, but your benefits have not.
We are here to help! Please call for more information about financing your oral health needs in our office!