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Pittsburg Dentist, Dentist in Pittsburg, KS

Robin F. Wood, DDS & Associates, LLC

 

Dedicated to Excellence in Dentistry

620-232-1000

FAQ
 

Our Practice Policies and Guidelines

Appointment and Financial Guidelines - Dental Insurance Guidelines

We believe in the value of clear communication, as well as mutual understanding and respect. We believe that our patients would like to know and understand our appointment, financial, and insurance guidelines in advance of their treatment. You will find these guidelines outlined below, however we are always happy to discuss your proposed treatment and any of our practice guidelines with you personally.

Appointment Guidelines:

It is our desire to provide high-quality dental care and individual attention for you in a timely manner. We pre-plan and prepare for your visit and hope you have done the same. Your appointment time has been reserved especially for you and we strongly encourage all patients to keep their appointments. When time is lost due to last-minute appointment changes, other patients in need of treatment cannot be seen and your treatment is delayed. Should any scheduling changes be required, we require at least 24 hours advance notice to avoid a cancellation fee.

We make every effort to remind patients by telephone or email prior to their appointment but please do not depend on this courtesy. We have found that with the recent popular use of answering machines, cell phones, pagers, and voice mail, some of our patients are not receiving these reminder calls. It is always helpful, if you use such devices, for you to return our call to confirm that you have received our message. If we are unable to contact you directly, your appointment card or your appointment phone call will serve as confirmation of your appointment and implies your obligation to be present at that prearranged date and time.

Financial Guidelines:

New Patients: Please supply complete insurance and account information to our office before your appointment so that we can verify your insurance benefits before treatment. Until we have received and verified the necessary account and insurance information, all treatment rendered on the first visit must be paid in full at the time of service. We happily accept cash, personal checks, or credit cards (MasterCard, Visa, and Discover.)

Established Patients: All of our fees or co-pays are due and payable at the time treatment is rendered. We will be happy to keep a credit card on file as a courtesy to our patients. For fees and co-pays over $500, we have several financial options available. For major treatment our staff will be happy to provide several financial options including outside financing through CareCredit for those who qualify.

Emergency Treatment: Emergency appointments are scheduled around our daily reserved patient appointments. We will try our best to get emergency patients in and treated as soon as possible. Our number one goal is to get you in and out of pain. Due to these circumstances our office will not be able to verify insurance benefits or limitations on your account before completing this unreserved treatment appointment. In order to schedule emergency treatment we ask that you cover the full fee for the emergency procedures at the time of service. If you have insurance, we will be happy to file it for you and credit back or apply any credit due at your request upon receipt of the insurance payment.

Dental Insurance Guidelines

We are glad you have dental insurance to provide you with partial assistance in affording your dental care. We are happy to assist you in filing the necessary forms to help you receive the full benefits of your dental insurance coverage as a courtesy to you at no additional cost. Dental insurance is different than most medical insurance plans and it is important to be aware of the following

  • The insurance relationship constitutes an agreement between the carrier, the employer, and the patient. Our dental office is not a party to that contract. As such, we can make no guarantee of estimated coverage or payment.
  • Insurance companies base the amounts they pay on restrictive fee schedules, regardless of what the actual fee might be. Our fees are often, but not necessarily, covered in full by the maximum allowance determined by your carrier.
  • Not all dental services that are necessary for proper dental health are a covered benefit in all contracts. This depends on the kind of plan you and/or your employer has purchased.
  • Deductibles and co-payments are built into most plans and their required payment is strictly regulated by state law. Your Employee Benefits or HR Director can usually help you become familiar with your plan and its restrictions.

Our responsibilities:

  1. Complete insurance claim forms and submit to your carrier within 24 hours of treatment
  2. Use current American Dental Association coding for correct reporting of procedures.
  3. Accept direct payment from your carrier and keep track of balances.
  4. If necessary, re-file your insurance a second time within a 30-60 day period.

Your responsibilities:

  1. To pay fees not covered by your plan at the time of treatment or as otherwise arranged.
  2. To provide our office with necessary information concerning your insurance coverage to allow correct filing of claims.
  3. To understand that your plan is a contract between you, your employer, and the insurance carrier. Our office will do all we can to facilitate claims payment, but we do not have the power to force your insurance company to pay.
  4. To pay any account balance not paid by insurance after 60 days and after 2 billing attempts.

Thank you for choosing our office for your dental needs. Please know that we will do everything possible to see that you receive the full benefits of your insurance policy.

Remember: By submitting your insurance information with our practice you hereby authorize payment of the insurance benefits otherwise payable to you to be made directly to this dental office. You understand that any insurance coverage estimate given to you by this office is not a guarantee of actual insurance payment. You also understand that you are ultimately responsible for all charges incurred for dentistry performed upon yourself or your dependents in this dental office. You have authorized the release of your dental/medical histories and other information about your dental treatment to third party payers.

Notice of Change in Guidelines for Secondary Insurance Patients

(Effective January 1st, 2008)

Due to a number of factors we will no longer be able to accept benefit payment or estimate benefits for patients with Secondary insurance coverage. Our practice is here to serve our patients to the best of our ability and that ability has been compromised over the last few years due to inaccurate coordination of benefits and payment on Secondary claims by most insurance plans. Over the years we have found that about 75% of Secondary claims are paid incorrectly due to the factors listed below:

Secondary Insurance Pays as Primary

Our practice submits Primary claims electronically so that they can be returned as soon as possible. As soon as we receive the Primary claim payment we attach the Primary Plans, Estimation of Benefits (EOB) to the Secondary claim and mail it to Secondary insurance. Primary and Secondary Plans are both listed on the claim and we always attach the Primary EOB to the claim. There is no excuse for the Secondary Plan to pay as Primary with all this information provided to them.

What does this mean to you?

What this means to you is that your insurance payment cannot be accurately determined and your claims cannot be closed and account cannot be cleared up until we have an accurate, final payment from your Secondary plan. This leaves all of us in limbo until this is completed. If Secondary insurance does not accurately coordinate benefits then we have to resubmit claims and start the whole process over. This process has taken from 2 months to over a year per claim to get an accurate coordination of benefits from several insurance companies.

Inaccurate and Incomplete Explanation of Benefits from Secondary Insurance

Secondary claims are processed totally different than Primary by most insurance companies. They have continued to provide our office with little more than a payment voucher instead of a detailed Explanation of Benefits for the Secondary claim services. They refuse to provide a detailed breakdown of each service by service date and do not breakdown what Primary paid and what Secondary is covering on each service code submitted on each claim. These payment vouchers do not supply us with detailed information on what services and what teeth they are paying (or not paying) on and why they have denied payment on a specific service. These are basic requirements in order for our office to communicate with our patients about payment of services.

What does this mean to you?

What this means to you is that our office will not have the information from Secondary insurance to accurately estimate your portion of the services performed in our office. It also means that if the Secondary insurance plan is denying coverage on a service completed in our office, we have no information on which service or why they have denied coverage. This means that you may have more out-of-pocket expenses than you expected on these services and it leaves our office in a position of billing you for the difference but having no means to indicate why they didnt pay for something on the Secondary claim.

Coordination of Benefits rules are not standardized

Coordination of Benefits are the rules that a Secondary insurance entity uses to determine how they are going to pay their portion of the benefits left over after the Primary payment. The Coordination of Benefit rules are not standardized in the industry for each insurance entity or type of Primary or Secondary plan. Also each state has different Coordination of Benefit rules for the plans issued in their state. In fact, most insurance entities can make up or use whatever rules they want to apply when coordinating payment for Secondary plans.

What does this mean to you?

This means that no one knows how a Secondary plan will coordinate or pay benefits on a Secondary claim. It means we cannot accurately estimate your coverage on services. It means that you may have 100% coverage, 50% coverage or 0% coverage on dental services depending on how plans coordinate. It means that you will not know your account status until many months after your services have been submitted by our office.

Secondary Insurance mishandles paper claims and EOBs

Secondary insurance companies routinely misplace paper claims and Explanation of Benefits information sent by our practice. We aggressively track each claim that leaves our office to make sure that they are received by insurance in the first 15 to 30 days. Most secondary claims have to be resent via fax or mail due to mishandling of paper claims by Secondary insurance companies. Other times the claim will be scanned into their system but the Primary EOB will not be found causing the claim to be denied or sent back to us for more information.

Change in Guidelines for our Practice

These factors have made it nearly impossible for our staff to accurately estimate your Secondary benefits and we are forced at this time to stop accepting benefit payment or estimating benefits on Secondary plans. We will enter your Secondary plan information into our system but will only be able to estimate based on your Primary plan benefits.

You will need to keep your statement of services and Primary Explanation of Benefits and contact your Secondary insurance company for details on direct reimbursement. We can no longer take responsibility for your Secondary plan benefits and any questions about claim payments should be directed to your Secondary insurance plan representatives. Since we will no longer be able estimate your Secondary benefits, we ask that you take care of any remaining portion of your bill, beyond the estimate of your Primary benefits, at the time of service.

Our Goal

Our goal has always been to provide outstanding customer service and dental care to our patients regardless of insurance coverage. It is unfortunate that situations beyond our control have caused these changes in guidelines for our practice. The previous factors have made it impossible for us to provide excellent customer service to our patients due to the lack of standardization and specific rules over Coordination of Benefits. If you have any questions about these changes please feel free to contact us or contact your Secondary plan representative for information about Coordination of Benefits.

 
 

Robin F. Wood, DDS & Associates, LLC

of Pittsburg, KS. Give us a call at 6202321000. We make beautiful smiles a reality. Quality dental care provided by Dentist Robin F. Wood and staff at our beautiful KS office. Providing a wide array of dental procedures including Implant Restorations, Fillings, Crowns, Whitening, Bridges, Smile Makeovers, Veneers, Teeth Whitening, and many other services. All of this available in our convenient location in Pittsburg, KS.

909 E. Centennial, Suite 4
Pittsburg KS 66762
6202321000