New Patients Welcome. Our office coordinates your benefits with many different
insurance companies that in turn sell many different plans to numerous
employers that purchase different variations of plans for different levels of
employees. These plans have benefits, benefits provisions, limitations,
co-pays and deductibles that are subject to change frequently.
In an attempt to stay current with countless changes, our office
previously subscribed to Trojan Professional Service, a service that maintained
our database of approximately 80,000 different dental plans for northern
California. Those plans are updated daily, and it became impossible to
give timely accurate information. We now rarely rely on any information
provided by third parties or even dental plans themselves. We now rely only on
the explanation of benefits (EOB) that accompanies the dental plan payment.
Coordinating your benefits with these plans can be complicated,
time intensive, and exhaust considerable patience. We ask that you keep us
informed of any changes to your plans just as soon as possible so that your
plan information is kept current.
We will gladly file your claim on your behalf, but if for any
reason, you would prefer to file the claim yourself, please let us know.
Kindly remember that medical and dental plans are limited and
often only pay for a portion of the charges for procedures that may be recommended for you.
Payments, and Credit Balances
The majority of dental plans will reimburse approximately
30%-80% of covered procedures, nothing for the most desirable procedures, and they will honor your assignment of
benefits to our office. Regrettably, some abusive plans like Delta Dental of
CA, refuse to honor your assignment of benefits to our office. Instead they will
send benefit checks along with the EOB to you. By doing that, those plans
like Delta Dental of CA substantially limit our access to information that will benefit you.
It is now our policy to handle every patient’s account in a
similar way regardless of dental or medical plans: we collect in full for our
services, bill your plan, and if benefits are paid they go onto your account.
If a credit balance results, it will be refunded to you promptly
upon your request. Alternatively, you may choose to leave a credit balance on
your account to reduce your future out-of-pocket costs.
California law demands that insurance plans pay within 30 days
of receiving a claim; plans regularly circumvent that law by
making endless requests for “additional information” or they may
claim to have neither received a claim nor the additional information. We are
helpless to stem that kind of abuse, and we may have to turn the matter over to
you to handle when we have reached an impasse. In that case, please consider
filing complaints against the plan with your employer and with the California
Department of Insurance at (916) 492-3500. See their website: http://www.insurance.ca.gov/0100-consumers/hcpmain.cfm to
file complaints and also get information via the Internet.
In the case of HMO plans
like Delta Dental of California, file
your complaints with the California Department of Managed Healthcare (877)
688-9891 or online at www.HMO/help.ca/gov.
For insurance plans similar to Blue Cross/Blue Shield, file your
complaints with the California Department of Insurance at (800) 927-4357 or
online at www.Insurance.ca.gov/.
Denti-Cal (California Dental Medicaid) is administered by Delta Dental
of California. File Denti-Cal complaints, including suspected fraud on the part of patients, doctors and Delta Dental of CA, with the Department of Health Services. http://www.dhcs.ca.gov/ .