Our Business Office Works with You and Your Insurance Company to Ensure a Smooth Experience
As a service to you, we file dental insurance for most dental plans. We are in-network providers for Physicians Plus, Delta Dental, American Dental Plan, Humana*, WEA, Momentum Insurance Plans (Unity), Cigna (Radius Plan), Dental. 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.
*We file out-of-network for Medicare and Medicare supplements with Humana.
Commonly Asked Insurance Questions
What should I bring to my first visit?
For your first appointment, we request that you arrive fifteen minutes prior to your appointment time to complete necessary paperwork. If you have completed your registration forms from the New Patient section of our website, and brought them with you, arriving five minutes prior to your appointment will be all that is necessary. Your appointment is scheduled with our hygienist for seventy minutes and includes a comprehensive examination by your dentist.
You also need to bring your dental and medical insurance cards. This ensures we have a copy of both on file for future reference. Please make sure all cards are up to date and not expired. Also, it is a good idea to read through your insurance booklet sent to you so you know just what is covered and what is not. Although we try our hardest to provide the most accurate estimates we can based on the breakdown the insurance gives us when we call to verify your eligibility, there are thousands upon thousands of insurance plans under just one insurance company alone, and it is your responsibility to know the insurance plan you purchased. If you have any questions, you can always call your insurance company or, if you arrive 20 minutes early, we would be happy to go over your plan with you before your appointment. NOTE: Your appointment is scheduled with our hygienist for seventy minutes and includes a comprehensive examination by your dentist.
What do I do if my dental insurance changes?
Even the simplest change can prevent your insurance claim from being processed correctly. You may still have the same dental insurance company, but your employer may have changed the plans offered (something they should inform you of during open season), or the insurance company might have made small changes to the plan you currently have.
If something did change and you do not make us aware of it, this can greatly impact your out of pocket portions due, or might even mean something that used to be covered might not be anymore, causing you to receive a bill for visits after the claims are denied. Even changes to the plan’s group number or your subscriber ID number can cause issues – it might not mean you won’t get coverage, but it can mean your claim is denied for incorrect information. When this happens, we have to try to contact the patient to get updated information, which 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 for your convenience, please be prepared to verify your insurance at every visit.
Please learn more about our Dental Membership Program if you’re looking for dental discount plans.
Why was my dental insurance claim denied?
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 wrong
- Your Subscriber Number or Group Number is wrong
- 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
How does Madison Family Dental Associates file claims?
Can dental insurance companies limit coverage?
Yes they can. Sometimes, even if your insurance says they cover a procedure, there can be fine print that limits or even eliminates that coverage in certain circumstances. For example, your plan may cover a crown at 50%, yet have a 1 year waiting period for all major services, which crowns are a part of. If you get a crown done within that time, your insurance will most likely deny all payment, and you could end up paying out of pocket for that crown instead of just 50% as you had expected.
There are many other types of restrictions that can change your coverage and surprise you with unexpected costs if you do not read through your insurance booklet each time you are sent a new one. Questions about coverage for procedures can best be answered by your insurance company. If you are questioning the availability of coverage for any work needed, ask us to send a pre-treatment estimate. This will give you a better idea as to what coverage you will have on treatment. Although it is still not a guarantee of benefit, it is still a good idea to send it if there’s any doubt of your out of pocket cost.