Patient Insurance Plans (Contracts): Insurance plans vary widely from provider to provider, employer to employer and patient to patient. We gain as much information from your insurance provider as possible to provide you with the most accurate estimates we can. However, it is your responsibility to understand your individual plan and its limitations. Insurance companies do not provide us with contracts they entered into with you. They only give us basic information on breakdown of what percentages they cover for a given category of treatment. You always have the option to call your insurance company for further clarification.
Secondary Insurance Plans: Secondary insurance plans make estimations extremely difficult. If you have a secondary plan we will do our best to estimate your financial obligations, however, having a secondary plan does not release you from all financial obligations.
Treatment Plans: After your initial appointment, and any other exam that yields need of treatment, a treatment plan will be made available to you with what we estimate your insurance will cover. We ask that you sign this treatment plan to show you've received it only. This is NOT consent for treatment, it solely shows that you have been given the suggested treatment and any alternate options that may be available. While we don’t recommend waiting on any necessary treatment, we will list the items in order of priority. If there are elective procedures for cosmetic reasons or other non-pathologic treatment options we will place them in an alternate treatment plan. If you have any questions on what treatment is necessary and what is elective please ask us.
Pre-Determinations: We will file pre-determinations if requested. We do not routinely file these with treatment that is needed due to cavities, fractures or other pathology as time is typically of the essence when treating these conditions. Pre-determinations can take up to 3-6 months to receive back from insurance companies and that could mean the difference between a routine filling and needing a root canal or possible loss of the tooth. Please take this into consideration when requesting them.
Insurance Filing: We will file primary and secondary insurance claims for you. If you prefer to file on your own please ask and we will provide you with the necessary paperwork.
Insurance Denials: Insurance companies periodically deny payment. Most of the time the denials are because they require additional information from us in the form of x-rays or explanations for why the treatment was needed. Most of these are resolved on the first appeal. Rarely insurance continues to deny payment after the initial appeal. Insurance allows us to file two appeals before they close the claim and require you to pay the difference. The appeals process can take up to a year to complete. If we get a denial after the first appeal we will notify you and keep you in the loop prior to making a secondary appeal to your insurance company. This may be a good time for you to contact your provider as they tend to listen more carefully when the patient gets involved. Your chances of getting them to pay is much higher when you get involved!
Silverstone Dental Insurance Contracts: If we are contracted with your insurance provider we are required to follow their fee schedules which are typically 25-35% lower than standard fees in the Colorado Springs area. They also require us to collect patient portions including full payment at the discounted rate if they deny payment. “Writing Off” the balance on denied payments constitutes insurance fraud, please do not request the balance to be written off. In the case of denial we will work with you on payments that will fit your budget and in accordance with our office policies.
Policies For Patients With Insurance Coverage