Insurance
Contracted Insurance Plans
It is the patient’s responsibility to provide Great River Oral Surgery proof of active insurance for each visit. Failure to provide such requirements could result in rescheduling your appointment and/or the requirement of you to pay your service in full.
If Great River Oral & Maxillofacial Surgery has a contract with your insurance company, we are happy to file your claims with them. PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We are not responsible for how your insurance company handles its claims, or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment.
As your treatment plan is developed, you will be provided a consultation regarding an estimate for that treatment plan. You are responsible for payment of estimated co-insurance or co-pay due, at the time of service.
- Blue Cross/ Blue Shield Medical Plans (PPO only)
- Dean Health Plans (WI only)
- Delta Dental of WI-Premier
- Blue Dental
- Delta Dental Plans (All PPO contracts)
- Group Health Cooperative (WI only)
- Quartz Health Plans (fully insured and self-insured plans only)
Non-Contracted Insurance Plans
Once again, we file claims as a courtesy to you. If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim. You must be familiar with your insurance benefits, as we will collect from you the estimated co-pay, deductible, co-insurance, or non-covered services at the time of your appointment.
It is important to recognize that your insurance policy is an agreement between you and your insurance company. We do not guarantee what your insurance will or will not do with each claim. Your benefit assignment does not take the place of your responsibility to pay for services received. Verification of benefits is not a guarantee of payment by your insurance company; final determination is made by your insurance company at the time the claim is received.
By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. After we receive final payment or denial from your insurance company, you will be billed for the remaining balance on your account. You are responsible for any balance on your account after 30 days of final insurance payment or denial.
If, after 60 days, your account remains unpaid, you will be responsible for the balance and the account may be turned over to an outside agency for assistance with collection. In the event of an overpayment on your account, a refund will be sent to you within 60 business days.
In the case of divorced parents, the parent bringing the child to the initial visit will be deemed responsible for payment. Please discuss payment plan prior to visiting our offices.
If you have any concerns or questions about billing or insurance, please call our Insurance and Billing Team at 563-582-5150.
Dental Insurance; the more you know…
Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90-100% of all dental fees – this is not true. Most plans only pay between 50-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with your insurance company.
Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
Insurance companies set their own schedules, and each company uses a different set of fees they consider reasonable. These reasonable fees may vary, because each company collects fee information from claims it processes.
Fact 3 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume a service fee is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible averages $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient).
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
