Insurance companies tell patients they have 80% coverage of a specific procedure. What they don’t tell patients is that this coverage is based on a set of fees the insurance has created. These fees the insurance creates is to save them money, thus holding the patient responsible for the remainder of the balance. Our team does everything they can to estimate the most accurate amount the insurance will cover so you know your obligation before treatment begins.
However, every plan used in our office has different deductibles, maximums, covered procedures and varying fee schedules. Sometimes we are unable to exactly estimate reimbursements and the insurance pays a little less than we expected. In this case the patient is ultimately responsible for the remaining balance. There are many times the insurance will pay more than we expect. In these cases, we will notify you immediately and give you the option of applying the balance to your account or writing you a check for the overage.