In-Network Insurance Carriers
An integral part of providing the Ultimate Patient Experience is to ensure that our patients are able to afford the care they need or want. Our team is proud to participate with a long list of insurance carriers to make treatment financially feasible for you. It is our goal to maximize your insurance benefits, so let’s take a look at how we can work with you and your insurance carrier to take the worry out of planning financially for your care.
aetna
aflac
ameritas
Blue cross blue shield
ppo
Blue cross blue shield
state medical
Blue cross blue shield
state basic & plus
cigna ppo
delta dental pro
dental health
alliance
guardian
humana ppo
medicaid (dental)
metlife
united concordia ppo
united concordia
tdp/addp
zelis
TERMS DEFINED
Benefit Maximum
the maximum dollar amount that your dental insurance will pay toward the cost of covered dental services and or treatment in a benefit plan year, typically a 12-month period.
Can I get an estimate over the phone before I decide to schedule a consultation?
Generally, no. Our Scheduling Specialists cannot provide treatment estimates over the phone for a couple of really important reasons we’ve listed below for your consideration. In some cases, our team may be able to provide a very broad ‘ballpark’ figure but those will all be given as fully out-of-pocket costs without your specific insurance factored in. The only way to receive a treatment plan estimate for your case, with your insurance factored in, is to complete a consultation with a surgeon.
Reasons why our Scheduling Specialists cannot Provide Treatment Estimates over the Phone
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Scheduling Specialists cannot diagnose and/or confirm a diagnosis
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Scheduling Specialists cannot assess medical history and/or need of a patient
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Scheduling Specialists cannot discuss treatment options outside of that which is listed on a referral, and can only be discussed within the circumstances of our patient care guidelines at Charleston Oral and Facial Surgery
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Scheduling Specialists cannot complete an insurance verification benefit review until an appointment is scheduled
Will my insurance cover the consultation? How will I know if I'm going to owe anything out-of-pocket?
After you schedule your consultation appointment, our in-house Insurance Verification team will get to work contacting the insurance companies you provided at the time of scheduling to verify your benefits. Our team requests the following information from your insurer to ensure we have current and correct information regarding your policy so that we are able to provide you with advance notice of any out-of-pocket charges you may incur during any stage of your care with our office.
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Eligibility
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Benefit Period + Policy Maximums
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Policy Deductible
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Coverage Percentages for Preventative Services like Consultations and Imaging
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Coverage Percentages for the Most Common Oral Surgery Surgical Codes like Extractions and Dental Implants
If our Insurance Verification team is unable to verify your benefits ahead of your appointment, our team will contact you to verify the information we have on file for you.
If our Insurance Verification team finds that you have met your eligibility allowances for your benefit maximum, exam or imaging frequency, or has found that you do not have coverage for an anticipated code, our Administrative team will contact you to advise of this information and provide you with out-of-pocket estimates. If you are expected to owe anything out-of-pocket at your visit, you are always offered the opportunity to reschedule your appointment without penalty (see Cancellation Policy) if you are unable to pay the anticipated amount owed on the day of your appointment.
Do I have to use my Dental Insurance?
No. If you prefer to pay out-of-pocket, we are not required to file claims to your dental insurance.
What if you are out-of-network with my insurance?
If our office or providers are out-of-network with your insurance carrier, we will very likely be aware of this at the time of scheduling or when we verify your insurance policy ahead of your arrival. If you are out-of-network, our team will notify you in advance of your appointment to advise you of what you would be expected to owe out-of-pocket. If you are not comfortable with proceeding with your appointment out-of-pocket, you may reschedule without concern for incurring any broken appointment charge as outlined in our cancellation policy.
If you proceed with care in our office as an out-of-network patient, we will provide you with the necessary paperwork to file for reimbursement from your insurance. Some carriers will reimburse for out-of-network care, some will not. We recommend checking with your insurance carrier prior to deciding whether or not to proceed as an out-of-network patient.