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), and DHA. 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 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.
What do I do if my dental insurance changes?
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.
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 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
How does Madison Family Dental Associates file claims?
Can dental insurance companies limit coverage?
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.