Finance & Insurance “FAQs”

1. DO YOU TAKE INSURANCE?
2. I HAVE INSURANCE. WILL I HAVE TO PAY FOR MY EXAM APPOINTMENT?
3. ARE YOUR DOCTORS IN MY INSURANCE NETWORK?
4. WHAT WILL MY TREATMENT COST?
5. WILL MY INSURANCE COVER THE COST?
6. WILL YOUR OFFICE SUBMIT A PRE-DETERMINATION REQUEST TO MY INSURANCE CARRIER?
7. DOES YOUR OFFICE ACCEPT MEDICAID PATIENTS?

ANSWERS TO FINANCE & INSURANCE FAQs

1. DO YOU TAKE INSURANCE?

We work with most major insurance carriers. When you come in, we will be happy to do a complimentary benefits check for you. It should be kept in mind that this is really a dental supplement with clear limits of payment and we encourage our patients to focus on their problem with disease first, looking at their dental supplement as a helping hand, not a source of complete payment. We ask that all new patients be prepared to pay for their initial appointment and x-rays, even if they have dental insurance. These initial fees can later be recovered from your insurance company if the expense is covered.

2. I HAVE INSURANCE. WILL I HAVE TO PAY FOR MY EXAM APPOINTMENT?

We are a fee for service practice and payment is due upon completion of your initial exam … however, we will be happy to electronically file your insurance claim for you. We will be happy to help with financial arrangements for later treatment as we assess your overall problem and what steps will be required to treat your disease state.

3. ARE YOUR DOCTORS IN MY INSURANCE NETWORK?

We work with any insurance plans that cover dental care, but some plans today make arrangements with private dentists to participate as “providers” under their plan. These doctors are then obligated to follow the “required plan coverages” for specific disease treatment plans or the doctor will not be reimbursed. Drs. Caldwell and Dimmitt, along with most dental specialists have found these arrangements to be too restrictive in respect to the involved treatment plans that they use in the treatment of advanced dental disease. Because of these limits of treatment, we do not “work as restricted providers” for any insurance “program” per se. We are thus referred to in those limited situations as “out of network” providers. In most of those cases, we are still covered, but at a fee that is often 10% less than a dentist who is a designated “provider”. We are generally covered under all insurance plans, except “closed panel” programs that do not allow you to see anyone except a surgeon who in under a specific contract with their insurance company. We strongly suggest that we first complete your examination and actually establish a diagnosis so a proper submission can sent to your insurance company to evaluate what, if any, benefits will be available in this specific situation. We offer several payment options that enable patients to choose our practice for the exceptional quality of care we are known to provide.

4. WHAT WILL MY TREATMENT COST?

Our New Patient Exam fee is $110.00. Since all patients present with different stages of disease, and other mitigating factors—like how long they’ve had their particular condition—your Periodontist must complete your Examination before establishing your individualized Treatment Plan and determining the associated fee. The fee for various types of Periodontal Therapy or Dental Implants can vary considerably, dependent upon the type of problems you present with, their complexity, and the amount of surgical time needed to correct them.

5. WILL MY INSURANCE COVER THE COST?

We work with most major Insurance Carriers, and our electronically-filed claims receive priority processing from them. When you come in for your first visit to our office, we will be happy to do a complimentary Benefits Check for you. Again, please remember to bring all medical and dental benefit information and cards to your Examination appointment.

The term “Dental Insurance” is really a misnomer. A more accurate description of this type of compensation agreement would be “Dental Supplement” because, unlike Health Insurance plans, most Dental Insurance Carriers have an annual “cap” or limit on how much they will pay toward your dental needs—even though they are aware that Periodontal Disease has a very direct and negative impact on your overall health. For example, the American Heart Association and the American Diabetes Association have both issued statements concerning the negative impact of active infection on your organs and their function.

Periodontal treatment is typically covered by Dental Insurance Plans at 80% of the total cost (leaving a 20% balance), and a “cap” or limit on the amount that will be paid per fiscal year. To further complicate the matter, if you’ve already had other treatment that year with your General Dentist or another Dental Specialist, you will need to deduct the amount of that prior treatment from your anticipated supplemental reimbursement. If that treatment has exhausted your annual allowed limit, then you will receive no supplemental help with treatment. This harsh reality is why most of our patients appreciate the broad spectrum of payment arrangements made available by Drs. Caldwell and Dimmitt.

6. WILL YOUR OFFICE SUBMIT A PREDETERMINATION OF BENEFITS FOR MY TREATMENT?

We will be happy to prepare a predetermination of benefits after a diagnosis and treatment plan have been established in your case. Patients must understand that this does not guarantee payment from the dental insurance company for the benefits that are to be predetermined. It is simply an estimate of benefits.

7. DOES YOUR OFFICE ACCEPT MEDICAID PATIENTS?

Absolutely! We accept all patients. However, our Medicaid patients must choose to pay privately for the treatment that they receive in our office because periodontal disease is not a covered procedure under Medicaid.