The Insurance Department of Village Family Dental has undergone various stages of training and dedicated to servicing our patients' needs as well as our staff. They have a working knowledge of insurance company policies and procedures and keep the office current on plan or policy changes.
The Insurance coordinators are responsible for performing a variety of tasks including filing claims, posting insurance payments and overseeing the entire insurance process. They are available at any time to answer your questions.
We make every effort to obtain our patients dental insurance information over the phone at the time they schedule their first visit. This allows our insurance department to be able to obtain a summary of their dental benefits prior to their appointment and to help facilitate the new patient process. If the insurance information is not provided then we verify it at the time of their appointment.
Once a patient is verified that they are eligible for benefits, a summary of their coverage is selected for their account. Once treatment is determined, a treatment plan will be entered in their account presented and signed by the patient as consent before treatment begins. We collect the patient portion at time of service and file an insurance claim for reimbursement to be paid directly to our office. Once the claim is processed any amount paid will be applied towards their account. Occasionally claims will be denied or more information will need to be provided. The insurance department will ensure that all means of reimbursement will be utilized. If there is a difference in the estimated insurance coverage and the actual amount paid or the claim is denied, then the patient is ultimately responsible for the balance. Patients must understand that our treatment plans are only an estimate and insurance companies are not always predictable.
Village Family Dental does not participate with most dental plans. We only participate as a Premier provider for Delta Dental provided thru commercial employers. We are also providers with Medicaid and NC HealthChoice programs. Even though we do not participate with most insurance companies, we are happy to assist our patients in filing their claims.
Insurance companies reimburse on a set of established fees that they call their UCR, “Usual, Customary and Reasonable” or MAC, “Maximum Allowable Charge”. These fees may be less than our actual charge. This doesn't mean that we overcharge our patients. Instead insurance companies are not regulated to keep their fees up-to-date necessary for our region. The cost for quality dental care has risen over the years but the levels of dental benefits has remained the same.
We bill our full fee to insurance companies and they process the claim based on their UCR fees, thus if they cover 80% on an endodontic procedure, then they will process at 80% of their UCR fee, not our submitted fee. See the following example:
|ADA Code||Submitted Fee||Allowed Fee(UCR)||Deductible||Payment Rate||Benefit Paid|
If our fees are above the companies UCR fees the patient is responsible for the difference.
We will provide our patients with a treatment plan to be signed, by the patient or guardian, prior to rendering dental services. This serves as consent as well as accepting responsibility for any balance due.
Many details are taken into consideration when preparing treatment plans such as deductibles, waiting periods, frequency limitations, etc.
Many of our patients will provide us with two dental policies for us to file for them. We file the primary policy and upon payment we will forward the claim to their secondary policy along with an EOB, or explanation of benefits, from the primary policy. The EOB is a payment statement showing how much was paid and how the claim was processed. Any policy that is considered to be secondary will require the primary EOB before the claim can be processed.
Treatment plans for any Major procedures (crowns, bridges, etc.) will only reflect payment from the primary policy. These procedures tend to have exclusions in the fine print such as a missing tooth clause, a prosthetic replacement clause, a non-duplication or carve-out clause, and the most famous…primary has paid the allowable. Insurance companies do not provide comprehensive benefit information to us therefore we do not know the limitations and rules they use to determine benefits. What this means to our patients is that their portion will be based on one policy, however we will still file the secondary policy for them and any overpayment will become a credit toward their account.
Patients may request us to file a pre-estimate prior to them scheduling their treatment. A pre-estimate will allow us to better interpret what their payment portion would be in advance, however it still would not be a guaranteed estimate. We may suggest these to our patients when they have large treatment plans or need extensive prosthodontic procedures.
Pre-estimates will only be filed for primary policies. Secondary policies are unreliable when a pre-estimate is filed because they will ALWAYS assume they are primary.
We will file the pre-estimate with all necessary documentation to the insurance plan. The average time it takes for a response is four weeks. Once we receive the processed pre-estimate, we will create a treatment plan based on the explanation provided. A copy of the new treatment plan, the EOB, and a cover letter will then be mailed to notify the patient.
The majority of insurance companies will not require prior approvals. Many just “suggest” or “recommend” them if over a certain dollar amount. We may still file them upon patient request as explained above.
To help our patients facilitate the cost of their treatment, several payment plans are available to them. These financial services are separate from Village Family Dental and result in a contract between the patient and that financial institution. These plans are utilized for large treatment plans, cash patients, services that their insurance company does not cover.
Care Credit is a leader in patient financing. With a comprehensive range of payment options, for treatment or procedures from $1,000 to over $25,000, Care Credit offers a plan and low monthly payments to fit nearly every budget. There is no interest plans and extended payment plans. Patients may apply by application from our office, online, or by calling the toll-free number.