At Cedar Valley Endodontics, LLC we make every effort to provide you with the finest care and the most convenient financial options. To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date. They can be reached by phone at Waterloo Office Phone Number (319) 233-0803.
For Patients With Insurance
Please understand that insurance policies are a contract between the policy holder and the insurance company. Our office is not a party of that contract. The filing of insurance claims is a courtesy that we gladly extend to our patients. You will be required to pay an estimated portion of the fees at the time services are rendered.
The estimated amount will vary depending on your insurance benefits quoted to our office based on maximum coverage for the calendar year and deductibles to be withheld. This is an estimate and not a guarantee of payment by your insurance company.
If the insurance carrier has not paid within 30 days of billing, or a balance is present upon receipt of payment from your insurance, any unpaid professional fees are due and payable in full by you.
NON-COVERED CHARGES: Please understand that not all services are a covered benefit in all contracts. Any charges not payable by your insurance carrier will require payment in full at the time services are rendered. Any account balances over 30 days will be subject to a 1.5% monthly finance charge (18% annual rate).
Please call if you have any questions or concerns regarding your initial visit.
Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
What is my maximum coverage per year? The maximum coverage per year differs with each different insurance plan. Dental insurance is never a “pay-all”; it is only an aid. This is often a surprise to the patients, because regardless of how much dental treatment they may need, the dental insurance company’s responsibility is usually capped at a relatively low amount.
What is a deductible? A deductible is the set amount you must pay before your insurance coverage begins. Please check with your insurance carrier to determine your deductible amount.
What is the percentage that my insurance will pay for your services? We will make an every effort to provide you with a reasonable estimate of what your plan is likely to pay. Unfortunately, because of such things as maximums, deductibles, non-covered procedures, etc. calculating the exact coverage is impossible.
Why was my benefit different than what I expected? Your dental benefit may vary for a number of reasons, such as:
- You have already used some or all of the benefits available from your dental insurance.
- Your insurance plan will pay only a percentage of the fee charged by your endodontist.
- The treatment you needed was not a covered benefit.
- You have not yet met your deductible.
- You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
Why can’t you tell me exactly how much I will owe you for the treatment? At the time of service, your portion of the payment responsibility is only an estimate. Our office will perform a benefit check to assess your benefits under your plan as well as complete the dental portion of your claim form and submit it on your behalf. The amount of the precise financial responsibility is determined by your dental insurance company after the claim has been filed. A final statement is then issued to you. We recommend directing questions about your claim to your insurance company.
Why isn’t the recommended treatment a covered benefit? Your treatment plan is individually tailored, and is not based on your dental insurance benefits or lack of benefits. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Therefore, not all endodontic treatment will be covered through your insurance plan. Some endodontic services (such as CBCT imaging for most dental plans) may be excluded. While we want to provide you with the highest possible quality of care, your dental insurance may cover only very basic services. The type of care you receive from our office is based upon our professional judgment and years of experience and not the coverage you receive from a dental benefit plan. We do not believe it is in your best interest to compromise any recommended care in order to accommodate your insurance program.
What is a dual coverage? This means that you have coverage from more than one dental plan. It is your responsibility to inform us which plan is your primary. If you fail to do so and your insurance company revokes the benefits paid on your behalf, you will assume the full responsibility for the fee.
“In-Network” vs. “Out-of-Network” If we are “in network” with your insurance company, this simply means we have a contractual agreement with that insurance to only charge an agreed fee for the procedures that they cover. The insurance company will then pay the appropriate percentage of that fee. If we are “out of network” with your insurance company, we do not have a contract with that insurance and you are fully responsible for what our office charges.
What happens if I used all of my benefits on my insurance? Once your annual maximum has been reached, the insurance company will not provide additional benefits for any dental service until the renewal period. Each insurance policy is different. Please read your policy so that you are aware of your benefits and limitations.
Your claim will be filed immediately, and benefits are expected to be paid within 30 days. The filing of an insurance claim does not relieve you of timely payment on your account. If the claim is not cleared by your carrier within 30 days, the unpaid portion will become the sole responsibility of the insured and/or the patient. You are responsible for any amounts your insurance company chooses not to pay, for whatever reason. Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly. We will gladly provide all pertinent information to you at no charge.
What is a “UCR” and how is it determined? “UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by our office. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.