Have you ever wondered how your insurance works?? Here is a short rundown of the insurance process. We hope it answers some of your questions.
First of all, we can submit to all dental insurance companies at our office, it doesn’t matter if we are in or out of network, we can still submit. Let us do a benefits check with your insurance company to find out what your coverage looks like at our office. We can do this at any time.
We are happy to call your insurance company for you, However, your insurance policy is a contract between you, your employer and your insurance company. We are not part of that contract. Our relationship is with you, not your insurance company. We will be happy to fill out a claim for any care that is covered by your dental insurance. Please remember that no insurance company attempts to cover all dental costs. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. The majority of insurances have a maximum allowance per year for each family member. At the beginning of your next benefit year, you will receive a new maximum, however, nothing can be carried over from year to year. It is your responsibility to pay any deductible amount, co-payment or any other balance not paid by your insurance company.
At our office we give you what is called a treatment plan, on that plan our computerEstimates what your insurance will cover for the procedures we are recommending. Please remember that these are always an estimate and that no insurance company will tell us what the exact amount to be paid will be, we find out the exact amount when we receive the Explanation of Benefits (EOB) and check in the mail. It usually takes 2-3 weeks for us to get this back from insurance companies. We collect all funds that are estimated not to be covered by insurance, on the day of service.
Your claim leaves our office electronically after you have been checked out, it then takes a day or two for it to process through at the insurance company and get to where it needs to go. Then the insurance claims department process’ your claim (which always takes several days for them to get to all of them), after that they send us an EOB and a check for payment on that claim as well as sending you a copy of the EOB. We don’t always receive EOB’s and payment the same exact day that you do, it is usually close but sometimes there is some lost time in the mail. We do receive and process insurance claims/checks daily at our office so that our records are always kept up to date.
When your insurance check gets to our office they are processed and entered onto your account immediately. If the insurance company ever pays more than our computer estimated, we will apply a credit to your account. You are welcome to leave the credit on your account for future use, or we would be happy to get you a check back for the difference. Sometimes they pay us less than estimated, if this happens, we will send you an invoice at the beginning of the next month.
Sometimes we get claims back that are denied, this does not mean they will never pay on that claim. It may just mean that there is some kind of information missing. We may call you to get additional information needed for the insurance company. Once we receive the information that we need, we will resubmit your claim into the process.
Please feel free to call us at (712) 239-5125 if you ever have any questions about your insurance and we will be happy to assist you.