DENTAL BENEFIT (INSURANCE) INFORMATION
As a patient of Carolina Oral and Maxillofacial Surgery Center, we are committed to providing you with the highest quality care and service. Because we are also concerned about the rising cost of healthcare, we make every effort to provide services in an efficient manner, reducing costs to you, the patient. We are happy to help you maximize reimbursement from your dental benefit provider; however, we must emphasize, as a health care provider, that our relationship is with you and not your insurance company. Often the assumption is made that if a person has insurance, then it is the insurance company who owes the doctor for his services. This assumption is incorrect. Insurance is a contract between you, your employer and your insurance provider – we are NOT a party to that contract. While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date services are rendered until paid in full. In addition, if an assignment of benefits is accepted by our office and your insurance carrier has not paid within sixty (60) days, you will be expected to immediately pay the remaining balance due. It is important that you provide our office with all of the necessary forms.
As Insurance companies often, differ in their policies regarding coverage of services that an Oral Surgeon’s office may provide. For this reason, your policy may require you (the subscriber) to pay nothing, a deductible, co-pay, and co-insurance or may require you to pay for the entire procedure or consultation, depending on the policy language. Please remember that most policies do not cover the full cost of surgical care, usually paying between 50-80% of costs under the maximum annual benefit (usually $1000 -$1500) and only after yearly deductible have been met by you. They are designed to reduce your out of pocket expenses but not to eliminate it completely.
Estimate of Benefits
Prior to your visit, we will contact your insurance company to request eligibility, your remaining allowance for the year, and a breakdown of your benefits for oral surgery service including policy limitation and exclusions. The information we receive from your insurance carrier is only an estimate. Payment for services is only determined after services are rendered and the insurance company reviews the claim.
At your request, we can submit for a Pre-Determination of Benefits before treatment is rendered. Response time to receive information back from an insurance company is approximately 4-6 weeks. A pre-determination does not guarantee an insurance payment; it is only a slightly more accurate way to attempt to determine what benefits are included in the policy that was purchased by your employer.
We are participating members for several insurance companies, including Delta Dental of North Carolina, MetLife, United Concordia, and North Carolina Medicaid. Our business office will be happy to work with you to determine the extent of your insurance coverage and the amount needed on or before your surgical appointment. If you have questions regarding our (contractual) participation with your insurance carrier, please speak with a Patient Care Representative BEFORE seeing the doctor.
Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
For more Frequently Asked Questions (FAQs) about dental benefits please click here.