Glenn Dental is in network with most PPO insurance companies. As an in network provider we can treat you using your insurance companies best plan fees. We will do our best to work with your insurance to maximize the insurance portion of your bill, thus reducing your total out of pocket. The final determination on the payment of claims lies with the insurance carrier. There may be instances where, despite our best efforts, that the insurance carrier denies a claim. If this happens, the responsibility for payment will go to the patient or their responsible party. Ultimately, we recommend you familiarize yourself with your policy. As a patient or responsible party, you have the right to request prior authorization for treatment to determine beforehand your financial responsibility for a procedure. This may delay treatment while we wait for a determination, but you will have a better sense of your actual out of pocket.
There are several items that will affect patient out of pocket expenses. These include but are not limited to:
The treatment goes over plan yearly maximum.
- If the patient exceeds their annual maximum all treatment costs after that amount are the responsibility of the patient or the patient’s responsible party.
I have not paid plan co-payment or reached plan deductible.
- Insurance companies have a deductible that must be paid as an out of pocket expense by the patient or their responsible party. This cannot be waived.
Insurance company denies any treatment.
- There are times when an insurance company may deny a claim. This may be to any number of exclusions that a policy may have. While we do our best to find exclusions on policies, due to the large differences between policies it is not always possible to find all exclusions. There are also times when treatment is absolutely warranted, however it may not meet the criteria requested by an insurance company.
My insurance company pays less than estimated.
- Insurance companies plans change frequently and often without notice. We update our coverage book as we post payments to ensure we have the most up to date fees, but there are times when the most current fee isn’t reflected in our system. Our treatment plans are estimates. The final determination regarding the final fee is determined by the insurance company. They will provide an Explanation of Benefits that will detail what they are paying, what the patient is to pay, and what the dentist is to accept.
I am not eligible for insurance.
- If your insurance has a waiting period (common on personal plans) or if your insurance has lapsed, any insurance share estimated that has not been paid by the insurance company will revert back to the patient or responsible party.
I prevent or delay payment by not complying with requests for insurance forms or signatures.
- In the event that insurance is requesting information regarding a patient (often times school records for patients over 21 or other reasons) the patient or responsible party must provide us with the information so we can adequately bill the insurance. If a claim is denied for insufficient information that was requested from the patient or responsible party that denied amount reverts to patient responsibility.
I do not complete treatment and it results in non-payment by the insurance company.
- Many cases require a patient return for a subsequent visit to complete. These can include crowns, bridges, implants, dentures and a number of other treatments. Many insurances pay upon delivery. These cases result in preparation and laboratory costs that will be assigned to the patient in the event that they do not come in for treatment.
Lab costs are incurred due to missed appointments
Patient or Responsible party receives payment for services from insurance company.
- Sometimes an insurance company will send their insurance payment directly to the patient or responsible party. If this happens you simply need to bring in or mail the check to us. We will apply it to your account. If you fail to bring in the check we will reassign the insurance share to patient share and the patient or responsible party will be responsible to pay.
It is important to remember. When having treatment performed the patient or responsible party is agreeing to honor the terms of their insurance plan. If an insurance plan denies a claim they are stating that the policy between the patient and the company does not cover the treatment provided. Likewise, per the terms of the plan, the patient is responsible for paying amounts not paid to the provider.
Glenn Dental will bill your insurance and provide them with all needed materials to process a claim. If we have not been paid within 60 days by a patient’s insurance company we reserve the right to transfer unpaid amounts to the patient share.