The purpose of this communication is to enable you to obtain the maximum benefits allowable under your insurance plan, when applicable, and to assist you in understanding our office policies.
We welcome and encourage direct and sincere discussion of services and fees prior to treatment in order to attempt to avoid misunderstandings. The financial obligation for the treatment we render to you is your responsibility. However, we will be pleased to assist you in submitting your completed claim form to your insurance company for reimbursement.
We will provide you an up-to-date estimate for out-of-pocket costs for your treatment. We are contracted with Aetna (medical and dental), Anthem Traditional (medical and dental), Healthspan, Medical Mutual (medical and dental), Cigna Dental, Connection Dental, Delta Dental-Premier, Metlife, Superior Dental, and United Healthcare-Dental.
Anthem PPO does not have any oral surgeon providers contracted nearby. Our Insurance professionals are happy to contact Anthem to get the claim processed as in-network.
Possible Limitation On Your Coverage
Most insurance plans will not pay for the entire cost of your care. Your policy may include one or more of the following limitations:
- A list of exclusions of certain procedures
- A co-payment provision
- A dollar limit on covered services
- A co-insurance clause
- A table of allowance
- A deductible clause
- Any combination of the above
Insurance plans vary considerably. We suggest that you determine if any of these limitations apply to your particular contract. Some insurance contracts contain a table of allowances or a schedule of benefits. These tables are not fee schedules, although they may be described as such in your contract. They are actually lists of the amount toward the surgeon’s actual fees, which your insurance company will pay under the terms of the contract. The insurance companies will try to confuse you by calling their fee schedule – USUAL, CUSTOMARY, AND REASONABLE (UCR). In some cases, these amounts may be less than that of the actual charges.
Should you wish to determine the benefits to which you are entitled under the provisions of your contract, we recommend that you contact your insurance company to obtain precise information about the extent of your coverage.
Our office takes the position that the determination of proper treatment is a matter to be decided between the doctor and the patient. Our office will assist you with predetermination of benefits and estimated expenses for the treatment. We will also furnish sufficient documentation to assist you in obtaining the benefit to which you are entitled. This policy is based upon the philosophy that the necessity, appropriateness, and quality of oral and maxillofacial surgery care are properly determined by knowledgeable professionals.
Denial Of Benefits
Realizing the importance of health insurance we urge you to become familiar with your insurance contract and utilize its benefits. In the event that you do not receive the benefit you believe you are entitled to from you insurance carrier, we suggest you contact your carrier and your employee benefits representative to request the appropriate professional review. If we can be of assistance to you in these endeavors, we will make every effort to do so.
Please bring your insurance information with you to the consultation or surgery so that we can expedite reimbursement.