INSURANCE INFORMATION

INSURANCE COVERAGE

If insurance is a priority in your care decision, it is always best to call your insurance company directly and determine your benefit coverage with them prior to coming to our office.  They are the best source of information for your contract between you as policyholder and them as insurance carrier.

We participate with several dental insurance companies but we are not contracted with any medical insurance. We will file any and all claims with your insurance providers, however, there are two exceptions: We opt out of Medicare and Medicaid, meaning we DO NOT send claims nor will you be allowed to send claims. We will take full fees for medical procedures at the time of service. To verify if we are a contracted dental provider and what benefits are included, please call your insurance company directly.

Medical – We are not contracted with any medical insurance companies (considered Out-of-Network). Once all claims have been submitted and processed, the insurance company should pay any applicable benefits directly to the policyholder. If the insurance company happens to pay us directly, and there is a credit balance on the account, we will issue a refund check to the responsible party on the account.

Dental – We are contracted with several dental insurance companies, (considered In-Network) therefore will honor allowables if offered by your insurance company. If you are basing your care decision on this factor, call your insurance company directly to verify with them if we are a contracted provider. It is also best to call our office to verify your specific insurance plan. There are times when an insurance company may show us as a participating provider but we don’t specifically contract for all plans for that provider.

PARTICIPATING DENTAL PROVIDERS (IN-NETWORK):

  • Aetna
  • Ameritas
  • Blue Cross Blue Shield (KC + GRID network)
  • Cigna DPPO (not Advantage or Total Network)  
  • Delta Dental (all states)
  • Freedom Network/Freedom Network Select
  • Humana PPO (not Gold or DEN)
  • Principal
  • Sun Life Financial (formerly Assurant)
  • United Concordia

When making a new patient appointment, we will ask for all current insurance information for the patient including: Name, date of birth, SSN# and employer of the policy holder.  We will also ask for the policyholder’s member ID# and group#. 

If complete insurance information is given to our office, our treatment coordinator will call the patient’s insurance company the day before the consultation to verify and notate benefits.  After Dr. Oakley has examined the patient during the consultation, these benefits can then be applied to diagnosed treatment plan and presented during the consultation.

NOTE: If we are able to verify and record eligible benefits for the patient prior to the appointment, an estimated co-pay may be collected in lieu of full fees at the time of service.

TREATMENT ESTIMATES WITH INSURANCE

During the consultation appointment, our treatment coordinator will present treatment costs, insurance payment estimates and out-of-pocket patient estimates. These estimates are dependent on Dr. Oakley’s in-person evaluation during the consultation and accurate verifiable dental insurance information given 24 hours prior to the consultation appointment. Treatment costs with or without insurance cannot be quoted over the phone due to the custom nature of the evaluation and treatment process for each patient. 

Once the treatment is completed and all insurance claims have been received, final patient responsibility will be determined, which may be different from the original treatment estimate.  Fees for services rendered are the responsibility of the patient or responsible party, regardless of insurance coverage or benefits.

FILING OF MULTIPLE INSURANCE POLICIES

If a patient has multiple insurance policies, claims will be filed and processed according to these insurance industry rules.

  1. Medical claims must be processed before dental claims.
  2. Primary insurance must be processed before secondary insurance.  (The filing order for Primary vs Secondary coverage usually is:  patient’s employer first then spouse’s employer second; For a child with insurance coverage through two parents, the birthday rule applies – the parent that  has the birthday that comes soonest in the calendar year first then 2nd birthday second)

Please refer to our financial policy page for information about billing statements and balances. If you have questions regarding your insurance, please contact your insurance company directly to determine status of your insurance claim(s) and whether further information is needed to process open claims.