Dental Insurance Benefits Policy
As a courtesy to our patients with dental insurance, we will verify your dental insurance benefits, submit pre-authorizations when requested or we deem necessary, and we will submit your claims to your insurance company. We will collect the estimated patient portion, including deductibles, for your treatment at the time of service. If for any reason at all dental services are not covered by your insurance company we will make every effort to appeal the decision but for any reason at all, the final balance is your responsibility. We will always show you the full amount of treatment and what we estimate insurance will pay, however, this is not a guarantee of coverage with your insurance plan. We strongly encourage you to reach out to your insurance company and learn about your benefits.
All co-pays and deductibles are estimates based on the information provided to us by your insurance company. Your dental insurance is a contract between you, your employer, and the insurance company. Your insurance company pays us based on the negotiated (discounted) fees that have been specified in your insurance contract/plan. Our estimated fees for service are based on the fee schedule provided to us by your insurance company. It is the patient’s and/or the policy holder’s responsibility to be aware of any and all restrictions, limitations, exclusions, non-covered services, alternate benefits, non-payable services, and frequency of treatment. It is important for you (the patient, policyholder, or responsible party) to be aware of your specific plan benefits and guidelines. You are responsible for any balance left unpaid by your insurance company.
Diagnosis and treatment recommendations made by the dental providers at Clearwater Dentistry are based on the standards set by the American Dental Association and the most current dental clinical research, not by insurance coverage. We diagnose and treatment plan based on the needs of each individual patient. Our treatment plans are designed to provide best possible outcomes regarding long-term survival of restorations or prostheses.
We will always ensure that you understand your diagnosis, talk with you about the dental treatment is recommended, and then review with you your financial responsibility for recommended treatment. Dental insurance is a great benefit, and we will work with you to maximize your benefits from your plan; insurance is a method of payment, not a method of treatment.
To assist our patients with ease of payment, we offer the following methods of acceptable payment: cash or check, Visa, Mastercard or Discover. We will also accept your HSA (health savings account) or flex spending benefit card. For patients that qualify, we offer a 6- or 12-month interest free payment plan through CareCredit.
Insurance
We are an In-Network provider with the following dental insurance companies:
Working with Dental Insurance
At Clearwater Dentistry, we strive to make treatment plans and insurance verifications as accurate as possible. We love to educate our patients about their benefits, and we try to present each patient with the most accurate estimate. We use fee schedules provided by your insurance company and enter the % insurance is estimated to cover with each individual plan that is presented to us. We also call insurance companies to verify if you as a patient, are active under your plan and we check on downgrades and frequencies of benefits prior to your first visit.
Throughout our conversation with your insurance company, they will review up your dental plan and your dental history and provide us with the most up-to-date information for your policy.
At the beginning of each call to dental insurance companies they will state: “Information given is NOT a guarantee of payment”.
To guarantee our patients the best possible outcome for insurance reimbursement, we go above and beyond to provide insurances with extensive documentation to justify the need for treatment. We take supporting dental X-rays and intra-oral photos along with sending very detailed clinical notes to your dental insurance company for reimbursement. Our process as your dental provider is to collect as much information at the time of service to send with your claim. We file those claims on the behalf of our patients as a courtesy.
What can I do as a patient to verify benefits on my behalf?
- Call the “1-800 number” on your benefits card and ask for your eligibility and benefits breakdown of comprehensive, basic and major services
- Ask if you have met your deductible yet
- Ask for any waiting periods, downgrades, or missing tooth clause
- Verify coverage of ADA codes from your treatment plan, example D0150
What to expect at your visit for treatment:
- We will collect the patient’s estimated portion at the time of service.
- After service is completed, we proceed with sending out the dental claim electronically to your insurance company.
- We have 3 attempts to appeal your claim, after which the remaining balance becomes the patient’s responsibility.
- As the patient, you also have the opportunity to contact your insurance company to appeal the claim on your own behalf as a last resort for them to remit their payment.
- After we have received the final response from your insurance company, we will begin our billing cycle process by sending electronic statements via email and text (Dentrix Ascend Pay). You will have the opportunity to receive a paper statement bill via USPS, by request.
Note: Diagnosis and treatment recommendations made by the dental providers at Clearwater Dentistry are based on the standards set by the American Dental Association and the most current dental clinical research, not by insurance coverage. We diagnose and treatment plan based on the needs of each individual patient. Our treatment plans are designed to provide best possible outcomes regarding long-term survival of restorations or prostheses.
