We want to make it as easy as possible for you to receive the highest standard of dental care based on your particular need and circumstance.
To that end, our practice accepts most major credit cards and insurance plans.
We are also pleased to accept CareCredit and are happy to assist you with enrollment applications.
As a courtesy to you, we will file insurance claims on your behalf and will work with your insurance provider to coordinate treatment authorizations.
We are not accepting new Medicaid patients at this time. Please contact your member support for a list of dentists who are currently accepting this coverage.
Dental Insurance Q & A
Q: DO YOU “TAKE” MY INSURANCE?
A: The answer is probably! We are a Preferred Provider (PPO) for most major insurance companies. Because of the shear number of companies and plans out there is not always possible for us to advise you with absolute certainty. The best thing to do is to call your plan administrator, your insurance company or go to their website and see if we are an accepted provider.
Q: WHY AREN’T YOU A PREFERRED PROVIDER (PPO) OR IN-NETWORK FOR MY INSURANCE?
A: Unfortunately, some insurance companies simply do not pay dental providers enough to cover the cost of materials and labor for a procedure. If you’re having a hard time finding a dentist that accepts your insurance you may have one of those low reimbursement companies.
Q: WHAT DOES PPO MEAN?
A: PPO means Preferred Provider Organization. Dentists and other healthcare professionals simply fill out forms and sign a contract stating that they will accept a certain fee for each service performed.
For example a doctor may say a procedure costs $150, but the insurance company says it’s going to pay $100 for it. Dentists and other healthcare professionals who are PPOs or “in-network” accept this discounted fee in exchange for being listed as a preferred provider for that insurance company. If we are “out of network” your insurance company may pay at a reduced rate or deny coverage. It is important that you check with your insurer to determine if our clinic is in your plan.
Q: DOES THE DENTIST BENEFIT FOR SIGNING UP TO BE A PPO?
A: No. Because of a contracted (reduced) reimbursement fee schedule, it is the patient and the insurance company who truly receive the most benefit in a PPO situation. The main benefit we receive is that we are listed as an accepted provider for your particular insurance coverage. We know that you can choose to go anywhere for your dental needs so we are appreciative each time a patient entrusts their care to us!
Q: I HAVE INSURANCE, SO WHY IS THERE AN OUT-OF-POCKET EXPENSE FOR MY TREATMENT?
A: Dental “insurance” is more of a benefits package rather than true insurance. Most dental coverage is actually part of a prepaid benefit plan that offsets the cost of your treatment, but doesn’t pay for it entirely. In general, dental insurance covers 80-100% of preventative (cleaning, exam and x-rays), up to 80% of restorative (minor fillings) and up to 50% of major work (crowns and bridges).
Q: YOU TOLD ME I OWED ONE AMOUNT, BUT NOW I HAVE A BILL FOR MORE. I THOUGHT MY INSURANCE COMPANY WAS SUPPOSED TO COVER THIS. WHAT HAPPENED?
A: We do our best to estimate your out of pocket expenses for treatment before you leave our office, but with a multitude of insurance companies and hundreds of individual plans it’s simply impossible for us to know all of them. The fees you incur for treatment are your responsibility so it is vital that you communicate directly with your insurer so you can know what they will and won’t cover before you accept treatment. Knowledge is power and we want you to get the full benefit owed to you by your insurance company.
Here are a few reasons why you may have received a bill from us:
- Your insurance plan paid a lower percentage than expected for the procedure.
- The treatment you needed was not covered by your plan.
- The insurance company decided you did not need a procedure that the doctor identified as necessary or downgraded a procedure code.
- You have not met your deductible.
- You have not reached the end of your plan’s waiting period and are ineligible for coverage.
- You’ve maxed out your plan (used up all your benefits on other procedures) and no longer have coverage until the plan resets next year.
- We may not be an “in-network” provider for your particular benefit plan.
Q: HOW LONG DOES IT TAKE FOR AN INSURANCE CLAIM TO BE PAID?
A: The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.
Q: THE DENTIST SAYS I NEED A CERTAIN PROCEDURE, BUT IT ISN’T COVERED BY MY INSURANCE. WHY NOT AND ISN’T THERE SOME OTHER PROCEDURE THAT WOULD WORK JUST THE SAME?
A: Our doctors diagnose and provide treatment based on what you need, not based on what your insurance covers. Some employers or insurance plans exclude coverage for necessary treatment to reduce their cost. If you’re having trouble affording your dental care, ask us! We accept most major credit cards and are happy to offer CareCredit as a financing option.
Q: WILL YOU CHANGE THE DATE OR PUT A DIFFERENT DATE ON MY PROCEDURE SO MY INSURANCE COMPANY WILL COVER IT?
A: No. This is insurance fraud. We are contracted with insurance companies to provide 100% honest information, otherwise our PPO relationship would be cancelled and our dental license revoked. Not to mention that we believe in providing honest, quality care because of who we are and what we believe. Dishonesty is never permitted in our office.
Q: WHAT IF I STILL HAVE QUESTIONS?
A: We will do our best to answer your questions, however, it is your responsibility to call your insurance company, visit their website or a meet with your plan administrator (often the human resources department of your employer) so that you fully understand your insurance coverage. We encourage you to learn as much as you can about your insurance so you can consider your treatment options and budget accordingly.
Q: I WANT TO TAKE CHARGE OF MY HEALTH. WHAT QUESTIONS SHOULD I ASK MY INSURANCE COMPANY/PLAN ADMINISTRATOR?
A: Your insurance company can provide you with a breakdown of your dental benefits, but there are six key things to ask about:
- Plan Year: Does your insurance follow a normal calendar year? (Jan. 1- Dec. 31) If not, what month and day does your plan year start and end?
- Yearly Maximum: What is your annual maximum benefit dollar amount?
- Waiting Periods/Age Limitations: Are there any waiting periods for benefits to begin or age limitations?
- Frequencies: How often does your plan cover cleanings, exams, x-rays, fluoride, and sealants?
- Composite Restorations: Does your plan reduce coverage to the rate of old-fashioned amalgam restoration material or does it cover up-to-date composite fillings?
- Percent Coverage: What percent does your insurance cover for:
- Basic Restorative?
- Major Restorative Treatment and Prosthodontics?
Once you have this information, bring it to us! It will help us understand your plan as well and help us better estimate your out-of-pocket expense.
Q: MY DENTAL INSURANCE HAS CHANGED. WHAT SHOULD I DO?
A: Most employers distribute new insurance cards occasionally without changing the plan, but sometimes a plan changes without the distribution of new cards or a new group number. It’s always best to ask. If your plan changes or you have a new insurance carrier, call us to let us know about these changes right away. We can update your chart before your next appointment, saving you time waiting and filling out forms in the office. Plus, this will increase the accuracy of your estimated out of pocket expense the next time you visit us!
Q: I SAW A DIFFERENT DENTIST THIS YEAR. HOW DO I KNOW HOW MUCH DENTAL BENEFIT I HAVE LEFT THIS YEAR?
A: You should call your insurance company and ask. It is also important that you let our business staff know about any dental appointments you have had at another office during the benefit year. This will help to ensure you receive your full benefit at upcoming appointments.
We hope this information was informative. As always, please give us a call if we can assist you with any further questions you might have!
Wagner Family Dentistry
does not accept Medicaid.