Insurance / Financial Information
For Patients Without Insurance Coverage
For your convenience, we accept personal checks, Visa, MasterCard, Discover, American Express and cash. Payment is due in full at the time of service.
For Patients With Insurance
For your convenience we accept most indemnity insurance plans. We will estimate your insurance coverage and you will be required to pay your portion at the time of service. Estimates of insurance payments are based on information available to us. We do not always full information regarding accurate calculation of coverage or usual and customary fee based for your individual plan. Some procedures may be exempt from coverage regardless of need. Although we do accept insurance assignment, you are responsible for all costs of dental services rendered regardless of insurance coverage.
Managed Care Participants
We do not participate with any HMO or PPO programs.
Medicare Patients
We do not participate with Medicare.
Personal Injury Cases
This office does not accept liens or bill for auto-accident or other liability or lawsuit-related cases. The patient is responsible for payment at the time service is provided.
Follow-up Visits
The initial post-operative office visit is included in your endodontic fee. Additional follow-up visits may be required and will be charged at our standard rate.
Cancellation of Appointments
Please give at least 24 hours notice if change of appointment is necessary, otherwise a charge may be made.
Explanation of Fees
Your fee for service includes your visit with the doctor and is based on the complexity of your treatment.
Insurance Benefit Information
Your endodontist wants you to understand how dental insurance works and how to make it work best for you. You should also understand how the treatment you endodontist provided works with you dental plan.
The contract your employer negotiated with your insurance carrier defines you dental benefits. Please read the benefit or insurance plan booklet provided by your employer so that you better understand your benefits. Various dental planes cover endodontic procedures at different payment levels and, as a result, your payment portion may vary.
This section answers frequently asked questions about dental benefits. If you do not find the answers to your questions, contact your plan or benefits administrator who can explain the details. If you see an insurance term with which you are not familiar, please see the Glossary of terms.
1. What is a “UCR” and how is it determined?
“UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method of determining the UCR, and the UCR has no relationship to the fee charged by your endodontist. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
2.Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the benefits available from your dental insurance.
- Your insurance plan paid only a percentage of the fee charged by your endodontist.
- The treatment you needed was not a covered benefit.
- You have not yet met your deductible.
- You have not reached the end of you plan’s waiting period and are currently ineligible for coverage.
3. Why isn’t the recommended treatment a covered benefit?
Your endodontist diagnoses and provides treatment based on his or her professional judgment and not on the cost of that care. Some employers or insurance planes exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although your endodontist deemed the treatment necessary.
4. How do in know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance check has been received by you endodontist.
5. How do I understand my Explanation of Benefits (EOB)?
Your Explanation of Benefits (EOB) contains a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay and charges that are and are not covered by your plan. The statement includes the following information: UCR, co-payment amount/patient portion, remaining benefits, deductible and benefit paid.
6. How long does it take for a claim to be paid?
The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15-60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. He or she wants to know if your insurance complaint does not pay with in the period allowed by your state law. A link to the names and addresses of commissioners is posted on the American Association of Endodontists’ Web site, www.aae.org.
7. Will my endodontist take my insurance?
Most endodontist fall in one or more categories, and there may more options than are described here. Some endodontists sign contracts with dental insurance carriers and agree to accept or “take” the payment offered by the insurance company as payment in full, even though it may not be the same amount as the endodontist charges for the procedure. These endodontists are Participating Providers in your plan.
Other endodontists do not sign contracts with dental insurance carriers but still accept or “take” insurance company payments. These endodontists are not contractually obligated to accept your insurance carrier’s payment as full compensation and are not Participating Providers. In this instance, you may be responsible for a payment portion over and above the percentage provided by your insurance company.
Still other endodontists are not Participating Providers and do not accept payments directly from your insurance carrier. In this case, your endodontist will ask that you be responsible for the entire fee but will assist you in filing your claim to receive insurance benefits directly from your insurance carrier.
8. What if I still have questions?
Your endodontist will do his or her best to answer all of your insurance questions. Please keep in mind that there are many insurance plans available and that you employer chooses you plan and you benefits. If you believe your benefits are inadequate, you may want to discuss the matter with plan administrator and explore appropriate alternatives.
Glossary of terms
Assignment of benefits - Authorization from the patient to the insurance carrier to forward payment directly to the endodontist for covered procedures.
Claim - Statement sent to an insurance carrier that lists the treatment performed, the date of that treatment and an itemization of associated costs. It serves as the basis for payment of benefits.
Contract - An agreement between your employer and your insurance carrier that typically describes the benefits of you dental plan.
Copayment - The part of the fee you owe the endodontist after your insurance carrier has paid its portion
Coverage The benefits available to you under your plan.
Customary fee - The fees your insurance carrier will pay for the specific procedure performed as opposed to the actual fees submitted for a specific endodontist procedure to establish the maximum benefit payable for that specific procedure.
Deductible - The amount you are responsible to pay before the insurance carrier will allow your benefit plan to pay the endodontist.
EOB - Identifies the benefits (the amount your insurance carrier is willing to pay) and charges covered by your plan.
Participating provider - An endodontist who signs a contractual agreement with the dental insurance carrier to provide care to eligible members.
Patient portion - The dollar amount that you will be responsible for paying if your insurance payment does not cover the entire fee.
Preauthorization - A statement from your insurance company indicating whether the required endodontic treatment will be covered under the terms of your plan.
Predetermination - An administrative procedure that required your endodontist to submit a treatment plan to your insurance carrier for approval before treatment begins.
UCR - A term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure.
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