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Important Insurance Information

At Mebane Pediatric Dentistry,
we want to make your child’s visit as convenient as possible.
 
As a courtesy to our patients, we help file most major dental insurance plans and even offer a 10% discount for our patients who will not be filing insurance with us!
 
Our office is in-network with select insurance plans.
 
Please call our office for details about which insurance companies we are in-network with!
 
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How are my child's dental benefits determined?

Each time a patient provides us with their dental insurance information we will complete a complimentary benefit check for you!

 

We want to ensure that your child is eligible for services before they are performed and we want to do our best in determining what insurance will cover. In contacting your dental insurance, we want to obtain the most accurate details, pertinent to your child’s treatment needs.

 

We will obtain a complete dental breakdown provided to us by your insurance company however, we do rely on the you, the subscriber to be the expert of your own insurance plan. 

 

How does federal healthcare law affect my child's dental coverage?

Before the federal healthcare law took effect, medical and dental plans were offered as separate products.

 

This fact still holds true but, now medical plans offered through the Federal Healthcare law have plans that offer embedded pediatric dental.

 

Because these plans are embedded into the medical policy, the dental portion of the plan follows medical plan guidelines.

 

What we have learned, is that for the most part a higher medical deductible will apply to dental services that apply to the deductible.

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What is a deductible?

A deductible is the fee an insurance expects the patient to pay out of pocket before services are covered at the delegated coinsurance.

 

For example, if the plan holds a $50.00 deductible and the service rendered applies to the deductible, the patient will be responsible for the fee of that procedure until it meets $50.00.

 

To expand, an x-ray may apply to the deductible with a fee of $22.00.

 

The patient will be expected to pay $22.00 with $28.00 remaining to meet the deductible.

 

After the $28.00 is met (from a remaining service completed that applies to the deductible) the service will be covered at the full coinsurance percentage mandated by the plan.

 

What is an annual maximum?

An annual maximum is the max-allowable amount that your insurance will pay out for each person per year.

 

Once this has been met and/or exceeded, the patient is held fully responsible for any remaining charges for services rendered.

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When is my patient payment for services expected and how is that calculated? 

Each time treatment is recommended by Dr. Yoo, we create a pre-treatment estimate.

 

This estimate reflects the fees contracted with your insurance company (or just our office fees if you are not in network) and the coinsurances (percentages) in which your plan covers that procedure.

 

Each pre-treatment estimate we provide will list the fee for the procedure, the estimated insurance portion as well as the estimated patient portion.

 

The estimated patient portion is what we know insurance will not cover based off the breakdown we’ve been provided.

 

When services are provided, we do expect that payment in full the same day.

What should I expect, financially, after services are rendered?

Just as we are told by insurance companies, we want our patients to be on the same page: nothing is final until the claim is received from the insurance company.

 

The pre-treatment estimate provided to you prior to your child’s treatment is exactly that; an estimate.

 

Anything not covered by your insurance company, Dr. Yoo holds legal right to rely on the patient for payment in full of anything remaining.

 

We gladly accept any questions regarding billing and coding to your insurance company, however if your insurance did not cover a certain procedure (for any reason) we ask you refer to your benefit booklet or an insurance company representative.

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What if I am out-of-network with Mebane Pediatric Dentistry?

Being in-network with a provider simply means that the dental provider and insurance provider have come to an agreement upon what fees the patient may be charged.

 

If your plan is out-of-network with Mebane Pediatric Dentistry the patient assumes the responsibility for the differences in each individual fee.

 

For example, if your child comes in for a routine cleaning and our office fee is $200, we will help file your out-of-network insurance plan.

 

If the insurance plan only covers $150, the patient is responsible for the remaining $50.

 

What if I have a secondary insurance?

Again, as a courtesy to our patients we will file your primary insurance claim for any treatment completed.

 

If a child has coverage through both parents, per the national birthday rule, the parent with the birthday that comes first in the year will be the primary holder, unless a coordination of benefits states otherwise.

 

If you wish to make a claim individually to your secondary insurance, we will provide you with a claim form and services rendered to aid in filing of that claim.

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