Even the simplest change can prevent your insurance claim from being processed correctly. You may still have the same insurance company but did the Group Number or Plan Number change? Did the Subscriber Number change?

To prevent this situation, please be prepared to verify your insurance at every visit.

Your 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 6 months or 2 times per year
• Not a covered benefit
• You have a waiting period for Major Restoration procedures
• There is a missing tooth clause

Please ask if you have a concern.

On the same day you receive services, your charges are entered. Within two business days of your visit, a claim is generated. We file most of our claims electronically unless an insurance carrier can not receive electronic claims. We also can send electronic x-ray attachments to your insurance company if they require it. This is done through a secure website to protect your privacy. If you are having major restorative procedures, your insurance company may require an x-ray, detailed information on why the procedure was done, or periodontal charting. We may also need additional information from you about previous dates that work was done on your teeth or how long a tooth has been missing.

If you or a family member is being seen as the result of an accident we will need your medical insurance. Your medical insurance is primary in these situations and needs to be filed prior to your dental insurance. Filing claims in this order will prevent most delays in the claim being paid.

• A car accident where you have injured or think you have injured a tooth
• A fall or trauma to the mouth that has injured a tooth

Your insurance company generally does not define biting on something hard and chipping or breaking your tooth as an accident.

• Contact your dentist within 24-48 hours of the accident
• Contact your medical & dental insurance companies within 24-48 hours of the accident
• Most insurance companies require you to be seen within 24-48 hours of the accident
• Give your medical insurance to the staff at the clinic at the time of your appointment

Yes they can. It is best to contact your medical insurance immediately to get directions from them as to what needs to be done for benefits to be received.

Contact your insurance company to see if there are any limitations. In most cases, if an exam was performed within 24-48 hours with documentation as to why restorative care cannot be completed at this time, this is sufficient.

Please contact your medical and dental insurance if you have any questions.

We will file all claims for the accident to your medical insurance first. If the medical insurance denies or only pays a portion we will coordinate benefits with your dental insurance. Please inform the staff of any follow up care that needs to be filed under the accident claim.

At the patient's request, we will send information to an insurance company for major services that have been recommended. This is done so the patient will know in advance if the services to be performed are covered under their insurance plan. This can also help patients plan for services that they would prefer to have done in the next benefit year.

Your insurance company does not guarantee they will pay this amount and it is ONLY an ESTIMATE of benefits.

Having services prior to the preauthorized work performed may use your remaining benefits or reduce the amount available.

For example:

• You will be having a crown done that costs $1000.
• You have a maximum benefit of 1,000 for the year
• You have used $400 in benefits already this year and have $600 remaining
• Your estimate of benefits for the crown is $475 ($50 deductible & 50% coverage)
• The estimate is that the insurance will pay $475 and you will pay $525 for the crown
• Before you have the crown done you will come in and have 4 fillings that uses $300 of your benefits
• You have the crown done and the insurance pays $300. Why?

• Maximum Benefit $1,000
• Used Benefits $400
• Filling Benefits $300
• Available Benefits $300
• Total Benefits Used $1,000

You exceeded your benefits so $175 of the estimate will now be part of the patient responsible balance. The insurance will pay $300 and you will pay $700.

Please ask your dental provider to preauthorize any future major restorative services if you have a concern for your patient responsible balance.

• Crown
• Root Canal
• Denture (Partial or Full)
• Bridge
• Periodontal Care

Yes, we recommend that multiple fillings, extractions or sealants be Preauthorized if you have a concern regarding benefits. Please ask us to preauthorize these services as this is not done without the request of the patient or parent.