Have you ever wondered how your dental insurance works with your Raleigh dentist? Here is a comprehensive guide to the insurance process at Wainright and Wassel, DDS. We hope it answers some of your questions and helps you maximize your dental benefits.
Table of Contents
- Insurance Coverage at Your Raleigh Dentist
- How We Process Your Dental Insurance
- Understanding Your Treatment Plan and Estimates
- The Claims Process Timeline
- Payment and Adjustments
- Handling Denied Claims
- Maximizing Your Dental Benefits
Insurance Coverage at Your Raleigh Dentist
First of all, at Wainright and Wassel, DDS, we can submit to all dental insurance companies, regardless of whether we are in or out of network with your specific plan. Your Raleigh dentist wants to make the insurance process as seamless as possible for you.
We’re happy to conduct a benefits check with your insurance company to determine what your coverage looks like at our office. This helps you understand your financial responsibility before treatment begins and allows us to provide you with the most accurate estimates possible. We can perform this benefits check at any time – just ask our friendly front desk team.
According to the National Association of Dental Plans, approximately 77% of Americans have dental benefits, yet many don’t fully understand how their coverage works. At Wainright and Wassel, DDS, we strive to help our patients navigate their insurance benefits effectively.
How We Process Your Dental Insurance
While we are happy to call your insurance company for you and handle claims submission, it’s important to understand that your insurance policy is a contract between you, your employer, and your insurance company. Your Raleigh dentist is not part of that contract. Our relationship is with you, not your insurance company.
We will gladly file claims for any care that is covered by your dental insurance. However, please remember that no insurance company attempts to cover all dental costs. Some companies pay fixed allowances for certain procedures, while others pay a percentage of the charge. The majority of insurance plans have a maximum allowance per year for each family member.
At the beginning of your next benefit year, you will receive a new maximum, but nothing can be carried over from year to year. It is your responsibility to pay any deductible amount, co-payment, or any other balance not paid by your insurance company.
Understanding Your Treatment Plan and Estimates
When you visit Wainright and Wassel, DDS, we provide you with a detailed treatment plan. On this plan, our system estimates what your insurance will cover for the procedures we’re recommending based on the information provided by your insurance company.
Please remember that these are always estimates, and no insurance company will tell us the exact amount to be paid until they process the claim. We find out the exact amount when we receive the Explanation of Benefits (EOB) and payment, which usually takes 2-3 weeks from the insurance company.
Your Raleigh dentist collects all funds that are estimated not to be covered by insurance on the day of service. This helps us maintain our practice and continue providing high-quality dental care to all our patients.
For complex treatment plans, we recommend reviewing the American Dental Association’s guide to understanding dental benefits to help you make informed decisions about your dental care.
The Claims Process Timeline
Your claim leaves our office electronically after you have been checked out. It then takes a day or two to process through the insurance company and get to where it needs to go. After that, the insurance claims department processes your claim (which always takes several days for them to complete), and then they send us an EOB and a check for payment on that claim, as well as sending you a copy of the EOB.
We don’t always receive EOBs and payments the same exact day that you do. It is usually close, but sometimes there is some delay in the mail. At Wainright and Wassel, DDS, we receive and process insurance claims/checks daily so that our records are always kept up to date.
Payment and Adjustments
When your insurance payment arrives at our Raleigh dentist office, we process and apply it to your account immediately. If the insurance company pays more than our system estimated, we will apply a credit to your account. You are welcome to leave the credit on your account for future use, or we would be happy to issue you a refund for the difference.
Sometimes insurance companies pay less than estimated. If this happens, we will send you an invoice at the beginning of the next month. According to a study by the American Dental Association’s Health Policy Institute, this discrepancy between estimated and actual insurance payments is one of the most common sources of confusion for dental patients.
Handling Denied Claims
Sometimes we receive claims that are denied, but this doesn’t necessarily mean they will never be paid. It may just indicate that some information is missing. Your Raleigh dentist’s office may call you to get additional information needed for the insurance company. Once we receive the information we need, we will resubmit your claim to restart the process.
Common reasons for denied claims include:
- Missing or incorrect information
- Services not covered under your specific plan
- Annual maximum benefits already reached
- Waiting periods not satisfied
- Frequency limitations (e.g., cleanings only covered twice per year)
Maximizing Your Dental Benefits
To get the most out of your dental insurance with your Raleigh dentist, consider these tips:
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Schedule preventive care regularly: Most dental insurance plans cover preventive services at 100%, including regular cleanings and exams.
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Plan major treatments strategically: If you need extensive work, your Raleigh dentist can help you plan treatment across calendar years to maximize your annual benefits.
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Use your FSA/HSA funds: Many dental procedures qualify for payment using these tax-advantaged accounts.
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Ask about payment plans: At Wainright and Wassel, DDS, we offer financing options for treatments not fully covered by insurance.
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Stay informed about your benefits: Know your annual maximum, when your benefit year resets, and what services are covered.
Please feel free to call us if you ever have any questions about your insurance and how it works with your Raleigh dentist. At Wainright and Wassel, DDS, we’re committed to helping you understand your benefits and maximize your dental insurance coverage.