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The following office policy is based on the fact that your insurance involves a legal contract between you and your insurance company or union. My office is not a part of this legal contract. All arrangements concerning your benefits should be between you and your insurance company.
Claim Forms
- If you know your benefits and simply want a claim form filed, please complete the patient's claim form and bring this to our office. We will complete the dentist's section and we will mail the claim form to your insurance company for you. We will file for the total fee at one time to initiate the reimbursement process from your insurance company to you directly.
- You should not need to, nor will we, fill out any additional claim forms during treatment, unless there is a change in treatment cost.
Confirmation of Eligibility
An alternative in helping to determine your benefits is for you to obtain a pretreatment estimate form at your place of employment. Our office will then complete this form for you to send in to your insurance company. After your insurance company forwards back to you a determination of your benefits, we will begin treatment and the receptionist will add the banding date to a copy of your pretreatment estimate form and check the active treatment box so you can file this form to start receiving benefits.
Payments
- All payments for orthodontic services rendered are made directly to this office by the adult patient or by parents. You understand that you are financially responsible to the doctor for all services rendered. Your insurance company or union is responsible to you for insurance benefits. You are expected to keep your account up to date with this office regardless of the insurance payment schedule of your insurance company or union.
- My office policy is not to accept direct payment from an insurance company. You have agreed to pay a set fee for my orthodontic services rendered. Any insurance money you receive or do not receive does not enter into that agreement between us. We want you to get all of the insurance money due you. The surest way to accomplish this goal is for you to accept your insurance money directly from the carrier. By your so doing, if any payment is not received by you which is due from the carrier, you have a most effective place to go for assistance. Your personnel manager or benefits manager where you work can see that you get all the dollars due you because he/she pays the premium for all the insured at work. This individual controls which insurance company will administrer the insurance and this gives him/her a great deal of influence with the insurance company. Needless to say, we do not pay premiums for the employees. Therefore, if we were to accept the insurance dollars direct and a payment problem occurred, we may not be able to get satisfaction from the carrier and then would have to turn to you for the balance. Insurance money going directly to you is in your best interest.
- Be sure NOT to sign the box on your form which authorizes payment to go to the doctor.
Verification of Continuing Treatment
You may be required to verify to your insurance company that treatment is continuing. However, it is not our office policy to provide proof of continuing treatment. It will be your responsibility to provide this information to your company by sending a copy of your cancelled check, our office receipt, or a copy of your ledger.
We also gladly accept the following credit cards:
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