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Patient Education

Dental Benefits & Direct Billing

Posted by OchRaKeR on July 17, 2019

One of the most common areas of concern for the dental patient are topics related to their Dental Benefit Coverage (Insurance). Below are a few of the most commonly asked questions.

Do you direct bill to the insurance company?
We will direct bill as long as the policyholders Benefit Provider will allow us and as long as we have an active credit card number on file to cover any unpaid balances. However, sometimes assignment of benefits will not be permitted due to benefit issues or balance on account issues. Also, there are a few policies which will not permit the benefits to be assigned to the dental office and will only forward payment to the patient; we require payment at the time of treatment in these instances.

How much will my insurance cover?
Unfortunately, we are unable to know exactly what every patient's dental benefits will pay. We will do our best to find out when asked - but it is the responsibility of the patient to know the details of their Dental Benefit Policy when changes occur to the plan, what is covered by the policy and who is covered under the policy. Sometimes your Benefits Provider will not let us know the information for your policy because of privacy legislation. It is helpful if you have a booklet or form with these details to bring to your appointment. Often you can also obtain this information from your Benefits Provider's website.

My dental insurance said it pays 100% for my dental treatment; what do you mean I still owe you money?
We hear this question often. Usually, the patient has looked at his EOB (explanation of benefits statement) which tells you what the provider paid or they check their plan booklet and sees that the fee charged by the dentist exceeds the fee guide amount set by the Benefit Provider. The problem is that the fee covered by the provider is whatever has been negotiated between your employer and the Benefit Provider, and is directly dependent upon the premium paid for your specific benefit policy. That is why the coverage can vary even between the employees of the same company or other patients covered by the same Benefit Provider.