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Week 5: Your Dentist and Your Dental Insurance

dental claim form, dental form, claim form, insurance form

Oops! We are a week late on this post! Our apologies if you've been waiting in intense anticipation for this final wrap-up to our series on dental insurance!

In the previous weeks, we tried to give you a little more insight in to what dental insurance is, and what you may expect from your benefits. We here at Lorna Lally DMD also do our very best to ensure that you receive the benefits that you should for any work completed at our office. There are a few ways in which we do so:

1. We check your insurance eligibility before your visit. We do our best to check each patient's eligibility before they are seen at our office to make sure there are no surprises or lapse in coverage. In order to help us with this, please call the office whenever your dental insurance changes, even if you don't have an appointment coming up because it's likely you will forget later!

2. We submit a dental claim form on your behalf. Technically, because the insurance contract is between yourself (or the subscriber) and the insurance company directly, it is therefore your contractual responsibility to apply for payment for any procedures that you or your dependents have done. Luckily, insurance companies allow us to act on your behalf and thus, we take on the task of telling the insurance the procedures which were preformed, as well as any other pertinent information about those procedures. This may include sending x-rays as proof that a certain treatment was necessary, providing additional details such as tooth numbers or tooth history, as well as using the correct codes for each procedure.

3. We will submit preauthorizations on your behalf. We understand that larger procedures are expensive and that you may want to be sure your insurance company will pay their part. We will submit a preauthorization request as well as the pertinent evidence to your insurance company to explain what procedure(s) we are recommending, and then contact you when we receive confirmation or denial of that request. That will also allow us to provide you with an updated estimate of your copayment.

4. We do our best to understand your benefits and provide you with accurate estimates. Though most preventative procedures (x-rays, cleanings, etc) tend to be covered fully, as mentioned in previous weeks, there will likely be an amount that you must pay for restorative procedures. We take the time to gather your plan information to the best of our ability and then provide you with an estimate of your associated copay for each procedure we recommend. Yes, there are times that we are incorrect because your plan has additional caveats, your annual maximum is reached, or some other factor out of our reasonable research, but we are proud that our estimates are accurate at least 85% of the time. This allows you to budget for procedures and also ask us questions about why certain things may be paid a certain way (for example, downgrades).

5. We fight for you. If payment we receive from your insurance company seems incorrect, we won't just send you the bill; we will go further and do research on your behalf. It is not unheard of that insurance plans make mistakes, especially since many claims are now processed electronically, so we make sure to look in to each discrepancy. This may require multiple phone calls, appeals, or other follow-ups, but we will always do our best to ensure you get the coverage you are owed. Rest assured that if you receive a bill you were not expecting, we have done our due diligence to ensure it is accurate.

So there you have it! Dental insurance in a (5 week) nutshell! Please reach out if we missed anything or haven't answered a question you may have! Remember, we are here for you!

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