Financial Policy and Insurance

insurance policyWe are committed to providing you with the best possible care. If you have dental or medical insurance, we will help you receive your maximum allowable benefits. We will be happy to help you process your insurance claim if you provide us with complete insurance information.

However, please keep this in mind:

  1. Your insurance is a contract between you and your insurance carrier.
  2. Our fees are generally considered to fall within the acceptable range by the majority of insurance companies.
  3. Not all services are a covered benefit in all insurance policies.
  4. Sometimes, not always, will Medical insurance pay for completely bone impacted tooth extractions.
  5. Drs. Blecha and Jandali is not enrolled with Medicare. Medicare does not pay for extraction of teeth. If your service is medical, we can render the medical treatment to you but Medicare will not pay for this treatment and you will have to pay these costs yourself.

Drs. Blecha and Jandali is not enrolled in any Dental HMO or DMO and we cannot submit claims to them.

Drs. Blecha and Jandali is a provider for Delta Dental Premier. All other insurance companies will be considered out of network. We will submit claims to them for you, on your behalf.
Drs. Blecha and Jandali is a provider for medical plans under Illinois Health Partners. The patient enrolled in such a plan will need a referral from their primary care physician to see Drs. Blecha and Jandali. After an initial examination with Drs. Blecha and Jandali, our office will help you in determining whether this is a covered procedure under your medical plan.

PROCEDURES COVERED BY DENTAL INSURANCE

Patients who provide us with complete insurance coverage information will be required to pay one half of the surgical fee on the day of service. For dental implant procedures, please refer to the treatment plan that will be presented to you.

Please note that the total fee for your dental procedures is your obligation. Once your dental insurance has responded, any remaining fees are your responsibility. If your dental insurance carrier has not paid within 60 days following a claim, the entire balance is due and payable at that time.

At that time options (1) and (2) below can be arranged if there is a need to do so.
We will send you a monthly statement. Most insurance companies will respond within four to six weeks. However, we live in a time with complex and highly variable medical and dental interactions that may require us to file claims in certain ways that delay claims processing. Please call our office if your statement does not reflect your insurance payment within that time frame. Often the patient is notified by their insurance company of a payment to us before we have actually received that payment. If a refund is due to a patient, we will promptly issue a check after we have received the insurance payment. Any remaining balance after your insurance has paid is your responsibility.

PATIENTS WITH NO DENTAL INSURANCE

Patients who do not have dental insurance will be required to make full payment at the time the service is rendered. If this is not possible, the following options are available:

Option 1 – Make full payment to the office with Care Credit. This plan allows for twelve monthly payments, interest free, for charges greater than $300.

Option 2 – Allow us to withdraw from your credit card (Visa or Master Card), one half of the charges at the time service is rendered followed by two additional monthly payments.

PATIENTS WITH TRADITIONAL MEDICAL INSURANCE COVERAGE (NOT A HMO)

Teeth extractions and dental implants are not covered by most medical insurance policies. Thus we ask patients to pay for services as outlined above in the section for procedures covered by dental insurance. For patients having jaw repositioning (orthognathic) surgical procedures, please refer to the treatment plan that will be presented to you.

PATIENTS WITH HMO MEDICAL INSURANCE COVERAGE (ILLINOIS HEALTH PARTNER PLANS ONLY)

These patients are required by their insurance to have approval for specific surgical procedures prior to having surgery. For HMO covered procedures, the patient may have a co-pay to pay themselves. Some procedures may be covered entirely by the HMO, but some procedures may be considered dental and are not covered by the HMO medical insurance. All procedures not covered by the HMO Medical insurance are the patient’s responsibility and payment is due for these non-covered dental procedures as outlined above.

CANCELLATIONS:

Our office requires a 24 hour cancellation notice for all tooth extraction surgeries. Dental implant procedures have a 72 hour cancellation notice as they require more time out of our schedule. If you fail to honor these cancellation policies, there may be a fee charged to your account.

Signature: ________________________________ Date: __________