There are many procedures performed in an Oral Surgeon’s office that may be covered as benefits under your medical plan. It is always suggested to contact your medical and dental insurance for verification of covered benefits. Marlene Houge, from our Crystal Lake office, offers these helpful tips to make your experience successful and to help you to better understand your benefits.
- Schedule a consultation to obtain a treatment plan that includes procedure codes. If you have an HMO policy contact your Primary Care Physician prior to your appointment to receive authorization and bring it with you.
- After your consultation REQUEST a predetermination for your treatment to be sent to your insurance. This will give you the estimated plan payment or acknowledgement of non-covered service.
- When speaking with your medical insurance ask, “Do I have oral surgery benefits under my plan?” Make sure you have the procedure codes ready. Get a breakdown of your benefits (deductible, co-insurance) and make sure you are getting the correct information for in-network or out of network providers. There is a difference. Always get the name of the person you speak with and date of the call, as this could help with an appeal or reprocessing of your claim if you were misquoted.
- Your dental insurance has a yearly maximum benefit amount each year. Once this amount is paid out it is called “benefits exhausted,” which means that the yearly maximum has been reached, therefore no additional payments will be made on claims for the remainder of the year. Your full yearly maximum amount will reset at the calendar year or plan year. Verify your benefits for this and covered services. Again, it is important to have your procedure codes ready.
- Know the order of your insurance policies for filing claims. Different factors are involved when there is more than one insured policy holder and multiple insurance plans. This is very important for filing your claims in proper order.
Together we can maximize your benefits and ensure proper processing of your claims. Please contact our office if you have questions; we are here to help.