Our team is committed to providing you with the best possible care, which includes in-office support to help you maximize the dental and medical benefits that are available. We are happy to assist with the processing of the insurance claim if you provide complete insurance information.
A few things to keep in mind:
- Insurance is an agreed contract between you and your insurance carrier.
- Our fees are structured to fall within the generally accepted range used by most insurance companies.
- Certain services do not qualify as covered benefits through insurance policies.
- There are times when medical insurance can be used for the billing of completely impacted tooth extractions.
- Drs. Blecha and Jandali are not enrolled with Medicare. Also, Medicare coverage does not include tooth extraction. If this service is needed, be aware that Medicare will not pay for the treatment, which means you will be responsible for the costs.
Our doctors are not enrolled in Dental DMO or HMO plans, which means that we cannot submit the claims to them.
We are a provider of Delta Dental Premier, so all other insurance companies are considered “out of network.” We can submit claims to them on your behalf.
We are a provider for medical plans through Illinois Health Partners. If you are enrolled in a plan through this provider, then you will need to bring a referral from your primary care physician to qualify for coverage in our oral surgery clinic. An initial examination can be done to determine if the procedure is covered through your medical plan.
What Procedures are Covered by Dental Insurance?
When complete insurance coverage information is provided, then one-half of the surgical fee will need to be paid at the time of service. A treatment plan will be presented for dental implant procedures; please review this information.
It is important to understand that you hold the obligation for the full payment of your dental procedures. A claim will be filed, then the dental insurance will respond with payment details. Any remaining fees will need to be paid by you.
If the dental insurance carrier has not issued payment within 60 days of filing a claim, then the whole balance will be due and will need to be paid by the patient at that time. In this case, we can arrange options (1) or (2) below.
You will receive a monthly statement, but it usually takes insurance companies 4–6 weeks to respond. Due to the highly complex medical and dental claims interactions, claims need to be filed in certain ways that often delay the processing. When you receive your statement, if it doesn’t reflect the insurance payment within the timeframe, then please call our office. Usually, patients are notified through the insurance company directly before the payment is remitted to our office.
When the insurance payment comes through and a refund is due to the patient, then the remaining balance will be promptly issued via check. If a balance is remaining after the insurance payment, it is your responsibility.
Patients with No Dental Insurance
Patients who don’t have dental insurance are required to pay the balance in full at the time of service. If you are unable to pay the total amount, then two options can be considered:
- Option #1: Care Credit can be used to pay the office. This plan is available for bills greater than $300, and it offers interest-free payments spread over twelve months.
- Option #2: A credit card payment can be made (Visa or MasterCard) to cover one-half of the total due. Two additional monthly payments will be withdrawn from the credit card to pay the balance in full.
Patients with Traditional Medical Insurance Coverage (Not HMO)
Most medical insurance policies do not cover tooth extractions or dental implants. So, patients are asked to pay for these services through the procedures outlined for dental insurance coverage. Please refer to the provided treatment plan if you are having orthognathic (jaw repositioning) surgery.
Patients with HMO Medical Insurance Coverage
This procedure applies to Illinois Health Partner Plans ONLY. Patients are required to have insurance approval for specific procedures before the surgery is completed. If it is an HMO covered procedure, then you may have a co-pay that needs to be paid at the time of the appointment. Some procedures are covered in full through HMO medical insurance, but other procedures are not covered. If the procedure is not covered by the HMO insurance plan, then it is the patient’s responsibility to pay the amount in full (as outlined above).
A cancellation notice of at least 24-hours is required for tooth extraction surgery. The cancellation notice for dental implants is 72-hours, since this procedure requires more time in our schedule. If the cancellation policy is not honored, then a fee may be charged to your account.