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FINANCIAL POLICY and INSURANCE AGREEMENT
Dental Insurance: Points to Consider

The following is a plain-language synopsis of most dental insurance contracts. Please read it carefully, and perhaps keep it for future reference.

• Dental insurance benefits do not work in the same way as medical insurance. There is almost always a co-payment due from the patient for almost every procedure.

• There are "deductibles" in all plans. At one time, these deductibles were never taken out of preventive treatment ("cleanings"). Recently many carriers have begun to take deductibles out of preventive treatment.

• Insurance companies do not typically provide seminars or instruction books on the best method to obtain the highest financial reimbursement benefits for the patient.

• Irrespective of any dental insurance benefits that might exist, the patient is always legally responsible for the entire cost of dental treatment.

• The extent of dental coverage is solely dependent on the dental insurance plan purchased by the employer. The higher the premium the employer pays, the greater the dental insurance benefits.

• Even if there is a written predetermination of benefits returned from the insurance carrier, it is possible that after treatment is provided, there are no insurance benefits payable.

• We (the dental office) have absolutely no power or leverage to deal with the insurance carrier. Only the employee or the contract purchases has power. Any complaints about benefits, payment or coverage should be directed to Human Resources or the company owner.

• The letters UCR on insurance vouchers stand for Usual, Customary, and Reasonable fee. The dollar amount you see as UCR has no basis in reality. It is an arbitrary amount determined solely by the plan selected and insurance premium paid by the employee. There is no relationship to the actual dental office fee. The better the plan (i.e., the more premium paid), the higher the UCR will be.

• A single insurance carrier may have a dozen different UCR fees for the same procedure, same office, and same dentist.

• There is no universal coverage and payment schedule established. Just because an insurance code describing a dental service exists, it does not guarantee that it will be a paid benefit under your policy. There are many dental procedures that are necessary, and many of them are preventive, but are not covered benefits.

• Financial benefits cannot be saved and carried over into the next year. Your dental benefits almost always have a yearly maximum contribution level. This amount is the MOST your insurance carrier is contractually obligated to pay during a defined year (calendar or otherwise). When this amount is reached, there will be no further dental benefits payable until the next benefit year. If you have already begun some additional dental treatment prior to the maximum being reached, the insurance carrier has no payment obligation beyond that of the annual maximum.

We are committed to providing you with the best possible care. If you have dental insurance, we are anxious to help you receive your maximum allowable benefits. In order to achieve this goal, we need your assistance and your understanding of our payment policy.

Payment for services is due at the time services are rendered unless payment arrangements have been approved in advance by the doctor. If you have dental insurance, we are happy to bill the insurance for you, but please be aware that billing the insurance is not a guarantee of payment.

1. Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract.

2. Most insurance companies have a deductable that must be met before the company will pay their portion. If you have not met your deductable for the year, you are responsible for any charges until the deductable is met. Even after the deductable is met, most companies still only pay a percentage (such as 50% or 80%) and you will be responsible for the remainder.

3. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover. Dental offices are not able to change those services in favor of the patient.

In an effort to provide you with quality dental care; we have expanded our payment policy. We will use our expertise to help you obtain the maximum benefits from your insurance policy. We expect full payments when services are rendered unless prior arrangements are made.

Financial and Insurance
Forms of payment accepted: Checks, Cash, Visa and MasterCard.

Cash and Senior discounts offered.

We are a fee for service practice.

Please call our office to find out if we accept your insurance plan. Please click here to find out more about our insurance policy.

Different payment plans are available upon request, please contact our office for detailed information.

There is a $20.00 service fee for all returned checks.


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Greg Ganzkow DDS | www.ganzkowdds.com | (206) 542-3535
18528 Firlands Way North, Suite A, Shoreline, WA 98133



 

 

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