Here at Dr. Scott’s office, we are happy to work with each insurance carrier to maximize patient benefits. We are happy to bill insurance companies directly to be reimbursed for treatment. But at the end of the day it is the patient’s (or parent’s) responsibility to be familiar with benefits provided by each insurance plan. All questions regarding coverage of specific treatment should be addressed prior to treatment.
Learning the ins and outs of your insurance plan can be tedious and frustrating, so here’s ageneric breakdown for maneuvering your insurance plan and having the best experience working with all your healthcare providers!
DENTAL CLEANINGS AND EXAMS
Most dental insurance companies pay for 2 dental cleanings and exams per year. Some plans will pay for 2 exams in a 1 year period, but most plans pay for 1 exam every six months. Check your policy to see which applies to you. This will help minimize the risk of exceeding the number of allowable visits.
Dental x-rays are important. They allow us to see what is going on under the surface of the tooth. Most decay can’t be seen visually, so x-rays allow us to catch decay early and restore teeth before infection sets in. In our office we take a full set of x-rays once per year. Most insurance companies will pay for x-rays once per calendar year. However, there are cases in which the Doctor may have need to “watch” a tooth, requiring more frequent x-rays.
The American Academy of Pediatric Dentistry has found that topical fluoride should be utilized as part of a comprehensive preventative program. Dr. Scott recommends a fluoride varnish at each dental cleaning and exam. Fluoride varnish is often reimbursed twice per year; however the reimbursement trend is once per year. Check with your policy to see the frequency in which fluoride will be covered.
If your child would ever need to come back for a filling, a wiggle or any other restorative treatment, it is a good idea to go over your benefits in order to be able to expect an accurate patient portion. Many policies pay 80% of basic restorative treatment. However, often there are hidden deductibles and the range of coverage can vary from 50%-90%. Some plans have a specific list of “covered” and “non-covered” services. It is a good idea to be familiar with this list so there are no surprises after treatment is completed.
Here at Dr. Scott’s office, we offer a pre-treatment estimate for any patient that needs to return for restorative treatment. Our estimate is based on an average 80% coverage plan, but does not include any deductibles that you plan may have. Please be aware that if you need to know your exact benefits, you will need to contact your insurance company. Our office does not have this information on hand.
Insurance companies have up to 30 days to pay on a claim. The office sends a claim to the insurance company, and receives payment directly from them. After processing the payment, a bill is sent out for any remaining patient portion due. However, if we do not receive payment from your insurance carrier within 90 days, the patient will be responsible for payment of the treatment fees and collection of your benefits directly from your insurance carrier.
Our primary mission is to deliver the best and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible. If you have any questions regarding your individual plan, call your insurance company for a complete summary of benefits. If you have any questions regarding our office policies and how we work with insurance carriers, don’t hesitate to contact our office manager!