Dental insurance benefits help patients cover part or all of the cost of their dental care. Shawnessy Smiles offers our patients the convenience of direct billing to their insurance. Not all plans are the same, and it is important for you to understand your specific plan details. Please be aware that the average dental insurance may cover some, but not all of the cost of your required dental care. The dental fees we charge for our services are the usual and customary fees charged to all our patients, regardless if you have dental insurance or not. Your specific policy may base its eligible fee on a fixed fee schedule, which may or may not coincide with our usual fees. In some cases, there may be a difference in fees charged, after the insurance company reimburses our office. This discrepancy in fees is your responsibility and will be invoiced to you.
At Shawnessy Smiles, we would like to help you maximize your dental insurance benefits — please bring a copy of your plan details in order for us to help you get the most out of your dental insurance and for us to provide you with accurate estimates for your treatment.
At Shawnessy Smiles, we require payment for your estimated or exact patient portion on the day of service. For your convenience, we offer several payment options:
A) Yes, we follow the latest ADA&C Dental Fee Guide for all our billing.
A) Shawnessy Smiles offers direct billing as long as the policyholders Benefit Provider will allow us. In some cases, assignment of benefits will not be permitted due to the balance on account issues. Also, there are a few policies that will not permit the benefits to be assigned to the dental office and will only forward payment to the patient; we require payment at the time of treatment in these instances.
A) Unfortunately, we are unable to know exactly what every patient’s dental benefits will pay. We will do our best to provide you with an estimated patient portion, but it is the responsibility of the patient to know the details of their insurance plan and to inform us when changes occur to the plan, what is covered by the policy and who is covered under the policy.
Please be aware that due to privacy laws, we are not able to access information on your behalf from your insurance provider. It is helpful if you have a booklet or form with these details to bring to your appointment.
A) Estimates for your treatment are based on the most recent information we have on file. If you’re concerned about exactly what costs you’ll be responsible for, simply ask about our ‘Pre-Determination.’
A) A Pre-Determination provides you the exact cost of the treatment. Upon request, we will submit this information to your insurance provider before completing any treatment. While this may delay your treatment, you will know exactly what (if any) out-of-pocket costs you may be required to pay.
A) We require payment in full for your patient portion at the time of treatment. We accept MasterCard, Visa, American Express, Cash and Interac (Debit).
A) We’re happy to put together a detailed treatment plan with the associated costs clearly outlined so that you can budget for each appointment accordingly. We can also prioritize treatments so that you can attend to the most urgent treatments right away and then plan further treatments over time.
A) We hear this question often. Usually, the patient has looked at his EOB (explanation of benefits statement) which tells you what the provider paid, or they check their plan booklet and sees that the fee charged by the dentist exceeds the fee guide amount set by the Benefit Provider. The problem is that the fee covered by the provider is whatever has been negotiated between your employer and the Benefit Provider, and is directly dependent upon the premium paid for your specific benefit policy. That is why the coverage can vary even between the employees of the same company or other patients covered by the same Benefit Provider.