Assignment of Dental Benefits
As a courtesy to our patients we direct bill to benefit providers for dental claims. This mean that you are giving your benefits provider permission to pay our office directly for the cost covered for your dental treatment.
Your dental benefits policy is a contract between you, your employer and the benefits company. We are not a party to that contract. Our relationship is with you and not with your benefits provider. Benefit providers do not inform dental office of any changes to your plan. If you are notified by your employer or provider of any changes, please let us know prior to your appointment so we can update your records.
Some benefit providers do not allow assignment of benefits and pays directly to the insured. In this case, you would pay the full balance for the treatment rendered and our office will submit your claim electronically and payment will be sent to you directly.
You are responsible for all fees billed by our dental practice. Although we estimate your benefits portion, we cannot confirm their accuracy since the amount settled by your provider may be affected by such factors as annual limits, non-coverage of certain procedures, etc. We encourage you to be familiar with the terms of your dental plan. All charges not paid by your benefits provider are your responsibility, regardless for the reason for non-payment. Co-pay portions are due at the time treatment is rendered. For your convenience we accept Visa, Mastercard or Debit.
In order to submit your claim and to help you migrate your dental plan please bring your benefits card with the following information to your initial visit.
Information required to submit a claim:
– Name of benefit provider
– Name of subscriber (policy holder)
– Subscribers date of birth Employer Policy or Group #
– Certificate or ID #
Questions you should ask about your dental coverage in order for us to best help you regarding your benefits:
– What is the annual maximum allowed per patient:
– What is the anniversary date of the policy, i.e. Jan 1st calendar year, or benefit year:
– Is there an annual deductible? If yes, how much is it?
– Per person $
– Family Max $
– What year’s fee schedule are dental benefits paid on? i.e. current, previous year:
– How many units of scaling and/or root planning are covered:
– Based on: calendar year ____ rolling 9 or 12 months ____ benefit year:
– How may Recall appointments are allowed annually?
6 months ____ 9 months ____ 12 months
– What percentage of coverage is allowed for the following:
– Diagnostic/Preventative %
– Restorative %
– Endodontic %
– Periodontal %
– What is the annual maximum for Major treatment:
– Do you have an x-ray limitation:
– Is Endodontic Treatment classified as basic or major treatment:
– Are white fillings covered on molar teeth, or are they paid at the silver fee:
– What amount of the maximum is used to date for the current year:
– When was the last new patient or complete exam done?
– Are you eligible for either on your appointment date?
– When was your least Recall, Polishing and Fluoride done?