In order to simplify the process of billing insurance, our policy is as follows:
We require that our patients take full responsibility for their dental plans and coverages. A thorough knowledge of the dental plan, by the patient, is crucial to preventing any misunderstandings.
As a courtesy to our patients we will be happy to file a claim on your behalf but ultimately the responsibility for payment of the claim belongs to the patients. We do not have a contract with your insurance company, only you do. Therefore, we are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We will assist you in estimating your portion of the cost of treatment, but we cannot guarantee what your insurance will or will not do with each claim. Although we make every attempt to file claims accurately and to resolve errors if they occur, we cannot be responsible for any errors in filing your claims.
We file claims with all insurance companies and policies, but your insurance company may restrict benefits. Insurance companies contract with some dentists, preventing the dentist from disclosing certain information to their patients. Our office has found many of these contracts seriously infringe on the patient / doctor relationship (i.e. restrict what treatment options maybe discussed with the patient). Alamont Dental Associates is unwilling to sign any contract allowing insurance companies to control your treatment (i.e. we will allows recommend the best treatment for you, whether or not your insurance plan allows for that treatment option).
Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment status.
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. The data used to establish fees may be dated and are set by the insurance company so they can make a profit, too.
Insurance companies set their own schedules (without disclosing their method of determination), and each company uses a different set of fees. These allowable fees vary widely because each company collects fee information from claims it processes. The insurance company then uses this data to establish their fee schedule.
Dental insurance is meant to be an aid in receiving dental care, it was never designed nor intended to cover the total cost for treatment. On average, most dental insurance plans pay between 50%-80% of the average total fee. Some plans pay more, some pay less. The percentage paid may be determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.
If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You should be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file claims in a manner such that your insurance company will receive claims within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days, a finance charge may be added to your account each month until paid.