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.
PARTICIPATING INSURANCE
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.
PARTICIPATING PLANS:
AETNA
PPO
AMERITAS
PPO
ASSURANT/FORTIS
PPO
BCBS
of GA PPO
CIGNA
PPO
DELTA
DENTAL PPO & PREMIERE
DENTAL
WELLNESS PARTNERS PPO
DENTIMAX
(FEE SCHED)PPO
GENWORTH
FINANCIAL PPO
GUARDIAN
PPO
MetLife
PPO
PRINCIPAL
PPO
UNITED
CONCORDIA PPO
UNITED
HEALTHCARE DENTAL PPO
ADP
(American Dental Plan) 25%
Affordable
Family Health Services 25%
Carrington
20%
Compdent
25%
DentiCare
25%
Direct
Dental Plan 25%
National
Dental Plan 20%
ASP
(formerly NHCD) 25%
Signature
(GE Wellness) Fee Sched.
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