Paying for Dental Treatment at Smile Sarasota

Occasionally we have a new patient at Smile Sarasota with questions, especially if they have dental insurance. They are sometimes surprised to hear in the initial conversation when appointing that we request payment for our dental services at the time they are performed. Actually, this is very common with dental practices in Sarasota, Florida, whether or not the patient has dental insurance. Many patients are used to going to medical practices and just walking out and waiting for a bill from their MD, minus whatever Medicare or their medical insurance pays, and then they pay the difference to the doctor.

Dental insurance is very different for many reasons – read our Blog “It’s Not Really Insurance” for more info on that. Most patients have only partial reimbursement for the services covered by their dental insurance plan. Most dental insurance policies have a maximum benefit, usually less than $2000 per year, which cannot be exceeded regardless of the needs or wants of the patient. That being said, Smile Sarasota is what is called a ‘Fee for Service’ practice, which simply means you pay for your treatment when it is rendered. In other words, if you consent to any dental procedures, it is your responsibility to pay on the day of service. It is the responsibility of the dental insurance carrier (a third party) to reimburse you directly for the portion of the procedure that is covered. The actual contract is between you, as the employee or retired employee (and the employer) and the insurance company. Many patients make the mistake of believing that the contract is between the dentist and the insurance company, and this is where misunderstanding begins. What you must understand is that a dental plan offered by your employer is merely meant to assist you in paying for the dental treatment that you require. The actual level of coverage that you have will depend on what is decided by you and/or your employer or union.

Please know that we are are a non-restricted practice and we work with all insurance companies who allow you to choose any dentist. (This is called PPO insurance). We are happy to file insurance claims for you – we file electronically, immediately, in most cases, and you can expect your reimbursement usually within a couple of weeks. As a matter of fact, it is now recommended that dentists do not accept direct payment (assignment) from insurance companies for many reasons. In addition to this, many companies and plans are now sending reimbursement to the patients anyway, regardless of whether or not the claim was assigned to the dentist or not. Sometimes we receive a check from an insurance company in error even though the patient has already paid in full and we have indicated on the claim form that this is the case. When this happens, we promptly return the check to the insurance company and ask that they send the check directly to YOU!

If you are unsure of your dental insurance coverage, we will be more than happy to contact your insurer and gain information as to exactly what is or is not a benefit. We can even submit pre-determinations or estimates of required future treatment and get a response of insurance responsibility for reimbursement to the patient, prior to treatment. Keep in mind that this is usually subject to a yearly maximum benefit amount and the year does not always begin on January 1. Also, Medicare does not pay for dental treatment unless you have a supplemental plan.

Ultimately it is your responsibility to understand your coverage and to pay for your dental work at the time it is rendered. If cost is a major concern, talk to us about it! We offer CareCredit and can assist you with the application process. They offer a no-interest plan if paid in full within six or twelve months. We will always give you a written estimate of your needed treatment before we proceed; and we always offer a 5% discount for any treatment over $1000 if paid by check or cash, which avoids credit card banking fees for us. So if you have any questions about paying for your dental care at Smile Sarasota, or about reimbursement from your dental insurance and how it works, don’t hesitate to call and one of our friendly patient coordinators will be glad to help you.

Sources and Credits: The American Dental Association, The Windsor Star, Dental Economics, Consumer Guide to Dentistry, Theresa Duncan/Odyssey Management