Dental Insurance Guidelines

Dental insurances may provide partial coverage for your treatment fees. As a courtesy to you, we are happy to assist you by submitting the necessary dental insurance forms on your behalf. Most dental insurance fillings take a greater amount of effort and time to complete as compared to any other medical insurance plans; as such it is crucial to be aware of the following:

1. The insurance relationship constitutes an agreement between the carrier, the employer, and the patient. Our dental office is not a party to that contract. As such, we can make no guarantee of actual coverage or payment.

2. Insurance companies base the amounts they pay on restrictive fee schedules, regardless of what the actual fee might be. Not all dental services that are necessary for proper dental health are a covered benefit in all contracts. Plans vary depending on what type of plan your employer has purchased for you.

3. Deductibles and co-payments are built into most plans and their required payment is strictly regulated by state law. We require full payment of this portion on the day services are rendered. Financial assistance is offered through Citi Health Card and Citibank. Please make prior arrangement with the front office staff if you would like to take advantage of their various interest free options.

4. Your Employee Benefits Director can help you become familiar with your plan and its restrictions.

Monthly statements will be mailed out to your address on file. It is your responsibility to keep us apprised of any changes in order to prevent unforeseen situations. Payment in full is due upon receipt of the statement. If full payment is not received, we will make one attempt to contact you by your email and after 90 days your account will be reported to a collection agency. We encourage you to contact us to discuss any billing issues and to contact your insurance company with any coverage issues that you might encounter. In cases of dispute with your insurance carrier, the disputed amount is due and payable by you. Once the issue is resolved, any monies recovered from your insurance company, will then be reimbursed to you.

Our responsibilities:

1. Complete insurance claim forms and submit to your carrier within 24 hours of treatment.

2. Use current American Dental Association coding for correct reporting of procedures.

3. Accept direct payment from your carrier and keep track of balances.

4. If necessary, re-file your insurance a second time within a 30-60 day period.

Your responsibilities:

1. To pay fees not covered by your plan at the time of treatment or as otherwise arranged.

2. To provide our office with necessary information concerning your insurance coverage to allow correct filing of claims.

3. To understand that your plan is a contract between you, your employer, and the insurance carrier. Our office will do all we can to facilitate claims payment, but we do not have the power to force your insurance company to pay.

4. To pay any account balance not paid by insurance after 30 days and after 2 billing attempts.

Please know that we will do everything possible to see that you receive the full benefits of your insurance policy.