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A patient waiting in the waiting area of Madison Family Dental Associates's office.Our Business Office works with you and your Insurance Company to ensure a smooth experience.

Dental Insurance


As a service to you, we file dental insurance for most dental plans*. We are in-network providers for Delta Dental, Delta Dental Medicare Advantage™, American Dental Plan, Humana**, WEA, Momentum Insurance Plans (Unity), Cigna (Radius Plan), DHA, and VA Community Care (CCN). Your payment or co-pay is required at the time of service. If you do not have dental insurance, we offer a 5% discount if payment is made with cash or check at the time of service. Unfortunatley, we do NOT accept Medicaid or Medicare.

We are also proud to now be part of both the Delta Dental PPO and Premier networks to better serve our patients. We are committed to offering you amazing care — by adding Delta Dental PPO and Delta Dental Premier to our networks, we are excited to maximize your benefits and make your overall dental experience even better.

**We file out-of-network for Medicare and Medicare supplements with Humana.

State Employees


If you are a state employee, your dental insurance will be Delta Dental, no matter who your medical insurance is through. Madison Family Dental Associates will continue to be an in-network Delta Dental provider.

History


The state of Wisconsin added a dental benefit to their medical insurance plan back in the early 1980’s. In the Madison area that benefit was added to the three medical HMO’s serving the area. Madison Family Dental Associates has served as the administrator of the dental benefit and as a premier provider for the Physicians Plus network since the plans creation. We have also served as a provider for the Unity/Momentum plan for over 10 years.

So what does this mean for you? Will you still be able to remain a patient at MFDA?


Yes! You will still be able to continue your care with Madison Family Dental Associates!

The contracted provider for the new state of Wisconsin dental plan is Delta Dental of Wisconsin, and Madison Family Dental Associates has been a longstanding provider of care for Delta Dental. Although the state has not released any official information on the insurance plan, we have been in direct contact with Delta Dental. They are also waiting for finalized information but are not anticipating any changes for us. We look forward to continuing to serve you long into the future!

Do I have any other options?


If you are frustrated with high insurance premiums and have issues with the insurance companies dictating the care you are receiving, Madison Family Dental Associates has developed our own Membership Program to replace your insurance plan. It is a prepaid program at a significant savings for you and your family to have preventive care (teeth cleaning, exams, x-rays and fluoride for children). Any other care that may be needed is done at a reduced rate.

*Note that this is not in addition to your insurance but is another option to replace your insurance.

Commonly Asked Insurance Questions


Q. What should I bring to my first visit?




A. For your first appointment, we request that you arrive fifteen minutes early to complete necessary paperwork. If you’ve already filled out the New Patient Form, which can be found here, we recommend arriving just five minutes prior to your appointment.

Please bring up-to-date dental and medical insurance cards, as we will make copies of both to have on file for future reference. Although we try our best to provide accurate out-of-pocket cost estimations, we advise you read through your insurance policy on your own so that you understand what services will and will not be covered. If you have any questions, we recommend you call your insurance company prior to the appointment, or arrive twenty minutes early to review your insurance policy with us.

Your first appointment is scheduled with a hygienist, but includes a comprehensive examination by a dentist. The appointment will take roughly seventy minutes.

Q. What do I do if my dental insurance changes?




A. Even a minor change can interfere with insurance claim processing. For example, your employer may have changed the plans offered (something they should infor you of), or the insurance company itself may have made a small update to your current plan.

If there is an update to your dental insurance, we ask that you notify us immediately, as even small changes can impact your out-of-pocket expenses. Even changes to the plan’s group number or your subscriber ID number can cause issues – in this case, your claim could be denied for incorrect information.

In the event of a denied claim, we attempt to contact our patients for updated information; however, relying on us in this manner is risky, as some plans won’t accept claims after a certain time period, whether there’s coverage or not. To prevent any of these situations, please be prepared to verify your insurance at every visit.

Looking for an alternative to dental insurance? Learn more about our Dental Membership Program, which includes dental discount plans.

Q. Why was my dental insurance claim denied?




A. Your dental insurance carrier can deny a claim for the following reasons:
•  Your name or the patient’s name is misspelled
•  The patient’s birth date is incorrect
•  Your subscriber number or group number is incorrect
•  The “student status” has not been updated with your insurance company
•  You did not see a provider within your network
•  Insurance has terminated
•  You have reached your benefit maximum for the year
•  Your insurance company only allows cleanings every six months or two times per year
•  Not a covered benefit
•  You have a waiting period for major restoration procedures
•  There is a missing tooth clause

Q. How does Madison Family Dental Associates Associates file claims?




A. On the same day that you receive service, we file our claims using a secure website, unless an insurance carrier cannot receive electronic claims. The next day, a claim is generated.
If you require major restorative procedures, your insurance company may require an x-ray, detailed information on why the procedure was completed, or periodontal charting. We may also need additional information from you regarding previous dental services or, in the event of a missing tooth, how long the tooth has been missing.

Q. Can dental insurance companies limit coverage?




A. Yes they can. Sometimes, even if your policy appears to cover a procedure, fine print can limit or even eliminate coverage under certain circumstances. For example, your plan may cover a crown at 50%, yet stipulate a one year waiting period for all major services, including crowns. In this case, your insurance will most likely deny payment, and you could end up paying out of pocket for the entire crown.

There are many other types of restrictions that can change your coverage or surprise you with unexpected costs, which is why we recommend carefully reading your insurance policy and contacting your insurance company with questions. If you have any doubt as to out-of-pocket cost, please contact us to send a pre-treatment estimate, which will give you a better idea as to what portion of the treatment cost will be covered.

Q. I’m on Medicaid. What information regarding dental coverage is available to me?




A. Since we are not a Medicaid provider, our Medicaid patients choose to pay cash for their services. If you do pay with cash or check (debit cards excluded), a discount of 5% will be applied. We also take debit and credit cards. We request payment on the day of service. To find a provider that does accept Medicaid, the best option is to call the customer service number on your card to ask for a list of in-network providers.
Logo for Madison Family Dental Associates


Madison:


5709 Odana Road,
Madison, WI 53719


608-274-5970

Hours


Mon - Thurs: 7 am - 7 pm
Friday: 7 am - 4 pm

DeForest


502 Nelson Court,
DeForest, WI 53532


608-846-3302

Hours


Monday: 8 am - 5 pm
Tuesday: 7 am - 4 pm
Wednesday: 8 am - 5 pm
Thursday: 8 am - 5 pm
Friday: Closed
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Madison Family Dental Associates, 5709 Odana Rd., Madison, WI 53719; 608-274-5970; madisonfamilydental.com; 7/22/2021; Related Terms: dentist Madison WI; dentist Madison WI;