UNDERSTANDING YOUR INSURANCE PLAN
An insurance policy is a contract between the insured (patient/guardian) and his/her insurance company. This office promises to makes every effort to verify your benefits and explain them to you in full before services are rendered. However, we cannot guarantee that the benefits taken over the phone between our office and your insurance company are always 100% accurate. Please note that all insurance companies have a disclaimer stating that they will not guarantee benefits or payment until a claim has been submitted.
When verifying if a procedure is covered or estimating your co-payment, this office goes by the information given to us by your insurance company at time benefits are verified. If your insurance company or benefits should change between the verification date and the appointment date it is your responsibility to inform us of such changes.
The information obtained is used to estimate the amount of your co-payment. A co-payment is the amount that is due to this office at the time of surgery, it usually entails the deductible, if not met and the percentage the insurance company deems patient responsibility. Please note, this in no way implies that the copay is the only part of the total charges you will be responsible for.
Below is a list of terms used when explaining your insurance policy.
Deductible – The amount an individual must pay for health/dental care expenses before insurance covers the costs. Often, insurance plans are based on yearly deductible amounts.
Plan Maximum – This term will apply to your Dental plan only. It is a predetermined amount the insurance company will pay out over the course of your plan year.
Co-Insurance – Refers to the amount you are required to pay for dental/medical care after a deductible has been met. In some dental/health care plans; co-insurance is called “co-payment.” Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the service and the insurance company pays 80 percent.
UCR (Usual & Customary Rate) – Is a term used to describe how much insurance companies are willing to allow for a specific procedure. Every insurance company has different UCRs and are usually not willing to divulge this information to a provider. If an insurance company verifies that they will cover 80% of UCR that does not imply they will cover 80% of the provider’s fee but what they deem usual and customary.
PPO (Preferred Provider Organization) – A group of Dentists and/or Doctors that are contracted with your insurance plan that provides you with the benefit of a reduced service fee, as opposed to the dentist/doctors standard fees. Under these plans you will have the option of going In Network or Out of Network.
HMO (Health Maintenance Organization) – Prepaid health plan, you must use the provider designated by the HMO in order for services to be covered by your insurance company.
In Network vs. Out of Network – An In Network provider is one that is contracted with your specific insurance company and will use a discounted fee schedule supplied by them. If you should decide to see a provider that is not on your plan then Out of Network benefits will apply. These benefits will pay based on UCR and usually carry a higher deductible & pay at a lower percentage than your In Network Benefits.
Dr. Tawadros is a dental participating provider on the following insurance plans, however it is advised that the patient/guardian call with all pertinent insurance information, so that eligibility and benefits can be verified prior to service being rendered.
Patients will be required to present their insurance card at the time of service.
BCBS of GA PPO
DELTA DENTAL PPO & PREMIERE
DENTAL WELLNESS PARTNERS PPO
DENTIMAX (FEE SCHED)PPO
GENWORTH FINANCIAL PPO
UNITED CONCORDIA PPO
UNITED HEALTHCARE DENTAL PPO
ADP (American Dental Plan) 25%
Affordable Family Health Services 25%
Direct Dental Plan 25%
National Dental Plan 20%
ASP (formerly NHCD) 25%
Signature (GE Wellness) Fee Sched.