Insurance Plans Accepted:
1. Delta Dental Plans
2. Aetna Dental PPO & DMO
3. Horizon BC/BS Dental PPO Plans
4. Cigna Dental PPO
5. Metlife and Metlife Tri-Care Dental Plans
Ramapo Valley Oral & Maxillofacial Surgery (RVOMFS) does not participate with any medical insurances, but will work with patients who have out of network benefits. Oxford and United Healthcare (UHC) Medical insurance will be accepted until March of 2012. After this date, Dr. Muduli will be considered a non participating provider who has opted out of the Oxford & UHC plans. In addition, we are happy to submit claims to medical insurances when necessary. We will also balance bill patients who have out of network benefits. We will estimate your co-pay based on insurance benefits. All we ask is that you forward the insurance payment check to our office when it arrives in the mail.
Interest free financing is also available through Care Credit. Please call our office to inquire regarding questions about financing options.
Payment is due when services are rendered. This is a standard office policy. We understand there are extenuating circumstances that may prevent a patient from making payment before a procedure. We will make exceptions when necessary to help our patients, but do not offer any payment plans. This is based on the discretion of the office manager.
Dental insurance co-pays are different from medical insurance co-pays. They are based on individual plans. Patients are expected to make payments based on their assignment of benefits. It is illegal to waive copays. All patients are treated equally at our office. Senior citizens are given a professional courtesy when they have no insurance. Patients with financial hardship may also be given a professional courtesy. This is applied on a case by case basis at the discretion of our office billing manager.
RVOMFS has opted out of Medicare. Medicare provides no coverage for oral surgery or dental procedures except for biopsy, pathology, and trauma. These patients must sign an advanced beneficiary notice (ABN) stating they have been made aware that they are entering into a private contactual relationship with RVOMFS, which doesn't participate with Medicare. Medicare patients will not be allowed to submit claims to Medicare. However, Medicare patients don't have coverage for the majority fo oral surgery procedures. (i.e. extractions, bone grafts, implants, sinus lifts, apico's and intra-venous general anesthesia) These stipulations also apply to patients seen in the hospital. Hospital patients are expected to honor fee for service charges. Emergent procedures in a hospital setting (i.e. infections and facial bone fractures) also do not fall under Medicare coverage with oral surgeons who have opted out of Medicare.
Our Office Policy Regarding Dental Insurance
If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not.
PLEASE UNDERSTAND that we file medical insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment, we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.
Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.
Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist's fee has exceeded the usual, customary, or reasonable fee ("UCR") used by the company.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.
Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the "allowable" UCR Fee. Frequently this data can be three to five years old and these "allowable" fees are set by the insurance company so they can make a net 20%-30% profit.
Unfortunately, insurance companies imply that your dentist is "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.