Insurance & Financing

Insurance & Payment Information

We are not a participating provider/in-network with most insurance plans. This means we do not sign contracts with the insurance companies so that we can put you at the center of your care. We believe it is important that our relationship is with you and not the insurance company.

We currently participate and are in network with CSEA dental insurance. We also accept and work closely with all major dental insurances, such as Metlife, Guardian, Delta, Excellus BCBS (Blue Cross Blue Shield), Aetna, etc. Most patients can use their dental benefits at our office. Our staff always give their best effort to help you get the most from your dental insurance for what you need.

If you have questions about coverage at our office for your specific insurance, please give our office a call and we will be happy to assist you.

How insurance works here:

• As a courtesy, we verify benefits and submit claims for you. To verify your insurance benefits and send claims to your insurance, we need the information on your insurance card prior to your scheduled appointment. We do not get notified from the insurance company if your insurance changes so please contact our office directly to let us know of any insurance changes or new insurance prior to your appointment to allow us time to verify it so that you can have the correct coverage.
• If your plan sends payment directly to us, we will wait for reimbursement for what we estimate your insurance will cover.
• You pay your estimated co-pay and deductible at the time of service. Our computer system generates an educated guess as to what your insurance may pay us based on historical data and the information your insurance company will give us which results in your copay for the day of service. This may be different than what the actual insurance reimbursement is and unfortunately we do not have control over what your insurance will pay.
• Any balance insurance does not cover is your responsibility and we will let you know if insurance pays less than expected. If insurance pays us more than expected, we will also inform you and return any excess to you directly.
• If insurance has not sent payment to us within six weeks, the remaining balance becomes due.
• If your plan is one that sends payment to you instead of to the office: full payment is due at your visit day of service, we will send the claim to your insurance for you, and insurance reimbursement will then go directly to you.

We can always provide our office fee for any treatment you need so that you can plan ahead. We can try to estimate what your insurance will cover based on what they have paid us in the past – however this is an educated guess. Because plans vary and frequently change, we cannot guarantee coverage or payment amounts. We are happy to send a pre-determination/pre-approval request to your insurance for you to get a more accurate estimate of insurance coverage if needed.

Important Insurance Terms to Understand

UCR (Usual Customary Rate)

Insurance companies base payment on their own fee schedule — not ours. Even if your plan says it pays “100%,” that usually means 100% of their fee, which may be lower than our fee. You may still have a balance after insurance pays for a procedure if the insurance fee schedule is lower than our office fee schedule. We are not given the fee schedules from insurances but we do keep a record of what common insurances have historically paid us to try to help you understand what type of coverage to expect.

Deductible & Co-Pay

Your deductible is the amount you must pay each year before insurance contributes. A co-pay is the portion insurance requires you to pay for a procedure – in other words what insurance will not cover on the procedure.

Annual Maximum

Most plans have a yearly dollar limit (often $1,000–$1,500) they will pay — even if more treatment is needed. Unfortunately, these limits have not meaningfully increased in decades. We get this information from your insurance and try to track it closely to let you know when you may run out of insurance benefits. Please be aware we do not always know if you have used some of your insurance at another office.

Predeterminations

For major treatment, some plans require advance approval. A pre-determination means that we send a list of treatment to the insurance to ask what they anticipate they will cover. This can delay care and does not guarantee payment. However, we are happy to send a predetermination to your insurance company on your behalf.

No Insurance?

We offer an in-house membership plan with discounted preventive care and reduced treatment fees for anyone who does not have insurance.

Payment & Financing

Payment is due at the time of service unless prior arrangements are made. We accept cash, check, and major credit cards. Financing options are available through Cherry and CareCredit.

We are happy to review fees in advance and help you plan treatment to fit your budget.