Insurance & Billing Information
Insurance and Billing Guidelines
Estimates … After meeting with our doctor and discussing the recommended treatment plan, our finance department will work up an estimate. This estimate will include insurance procedure codes, the description of procedures, and our standard fees (prior to any insurance contributions).
Pre-Authorizations … Your insurance plan is a contract between you, the patient, and your insurance company. If you have questions regarding your benefits, please contact your individual insurance with our estimate in hand. Patients are responsible for determining whether services are covered under their insurance plans. Benefits are not guaranteed. Oral & Maxillofacial Surgery Fox Cities does not automatically contact your insurance prior to your procedure. Some insurance companies no longer accept pre-treatment estimates. We ask patients to be responsible for knowing their insurance company’s guidelines and follow through with any special requirements. We are happy to assist if your insurance requires pre-authorization on a certain procedure, upon patient request
Insurance Companies … As a specialty practice, we see patients with many different types of insurance policies. We can file claims to most insurance companies, although we may not be considered preferred in-network providers with all companies. Preferred provider adjustments can only be taken if Oral & Maxillofacial Surgery Fox Cities, S.C. has signed a direct agreement/contract with that insurance organization. We cannot quote your actual insurance benefits due to the variance between medical and dental insurance plans. We are not providers for state Medical Assistance and government Marketplace plans, and we cannot file claims to those entities.
Medical vs. Dental Insurance … As oral surgeons, we must file all of our claims to medical insurance first and dental insurance second. Most medical plans tend to exclude tooth related procedures, but may allow some coverage for oral biopsies, TMJ, and accidental dental. Many dental plans offer some benefits for tooth related services, however your plan may have limitations such as annual maximums, waiting periods, and non-coordination policies (specifically with high deductible medical plans). We recommend that you look into your individual plan for covered benefits.
Medicare … Medicare plans have oral surgery limitations, and they do not cover the treatment of teeth and/or gums. Certain oral biopsies and injuries may have some coverage, but benefits cannot be guaranteed.
Sedation Options … Oral & Maxillofacial Surgery Fox Cities offers various forms of sedation options to our patients. Please note that sedation for certain procedures may not always be considered medically necessary by your insurance or be covered under your plan.
Oral Pathology … Some oral surgery may include biopsy or lesion excision. In these cases, a specimen is often sent to an outside lab for analysis. You will receive a separate billing invoice directly from the lab. Please alert our office if your insurance has specific lab requirements.
Payments … Insurance coverage varies widely from plan to plan and cannot be guaranteed. Our office requires a 20% down payment from insured patients on the day of surgery, along with a completed Final Payment Arrangement form. For those patients who are uninsured or fall into our non-covered benefit category (this includes medical insurance only, dental implants, and appliances), we require payment in full at the time of surgery which makes the patient eligible for a 5% discount. We accept cash, check, Visa, Master Card, Discover.
CareCredit … CareCredit is an outside financing option that our office offers to our patients. Upon credit approval, there are flexible deferred interest payment plans available for out of pocket expenses. Patients can easily apply in person at our office, online (www.carecredit.com), or by phone at 800-365-8295. CareCredit payment options are exempt from our 5% pay in full discount.