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In some cases, Dr. Pierri may participate with your plan, and we will accept “assignment of benefits.” We will bill the insurance company on your behalf, provided the proper paperwork is supplied to us in a timely fashion. We will also assist you in billing your secondary insurance carrier, if applicable, and in researching unpaid claims upon request.
However, because we may be unable to pre-authorize your insurance coverage before your first visit to the office, the fee for the consult and X-ray must be paid for at the time of the visit. You will be furnished with a copy of your paid bill which will contain all information necessary to file a claim to your insurance carrier for reimbursement.
Once a diagnosis and treatment plan has been established, we will help you obtain pre-authorization for your procedure. Every effort will be made to closely estimate your co-payment and deductible which are due at the time of service. The participating insurance payment will be accepted as payment-in-full only after all deductibles have been met and all co-payments have been collected.
Some benefit plans require pre-authorization and specialist referral forms from your primary physician. Please provide the proper Insurance plan identification and forms necessary prior to your visit.
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FOR NON-PARTICIPATION PLANS- POSSIBLE LIMITATIONS ON YOUR INSURANCE COVERAGE
Most health Insurance plans will not pay for the entire cost of your care. Your policy may include one or more of the following limitations:
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- A list of exclusions of certain procedures
- A co-payment provision
- A dollar limit on covered services
- A co-Insurance clause
- A table of allowance
- A deductible clause
- Primary care MD Referral
- Any combination of the above
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Insurance plans vary considerably. We suggest that you determine which of these limitations apply to your particular contract. Always document the name of the person you spoke to at the insurance company, their phone extension and the date and time of day of your call.
Some health insurance contracts contain a “table of allowances” or a “schedule of benefits.” These tables are not fee schedules, although they may be described as such in your contract. They are actually lists of the amounts toward the surgeon’s actual fees which your insurance company will pay under the terms of the contract. In some cases, these amounts may be less than the actual fees based on the premiums paid, etc.
Should you wish to determine the benefits to which you are entitled under the provisions of your contract, we recommend that you contact your employer, union, or insurance agent to obtain precise information about the extent of your coverage.
AVOIDING MISUNDERSTANDINGS
Our office takes the position that the determination of proper treatment is a matter to be decided between the doctor and patient.
Our office will assist you with pre-determination of benefits and estimated expenses for treatment upon request. We will also furnish sufficient documentation to assist you in obtaining the benefits to which you are entitled. This policy is based upon the philosophy that the necessity, appropriateness and quality of the oral and maxillofacial surgery care is properly determined by knowledgeable professionals.
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DENIAL OF BENEFITS
We hope that the information provided will be helpful to you. Realizing the importance of health insurance to your well-being, we urge you to become familiar with your health insurance contract and utilize its benefits.
In the event that you do not receive the benefits to which you believe you are entitled from your insurance carrier, we suggest that you contact your carrier and your employee benefits representative to request the appropriate professional review. If we can be of assistance to you in these endeavors, we will make every effort to do so.
SURGERY FEES
Regardless of insurance, all financial arrangements are to be finalized prior to care being rendered to avoid any misunderstandings later.
NON-COVERED CHARGES
All co-payments, deductibles and payments for non-covered surgical procedures are due prior to your surgery. Prior authorization may be required by your insurance carrier and is your responsibility, as insurance is a contract between you and your insurance company. Occasionally, unforeseen surgical procedures may be provided and are the responsibility of the patient/guardian.
FOLLOW-UP VISITS
Global care is provided immediately after surgery and is a covered benefit, however occasionally post-operative complications may ensue that require additional fees for which the patient is responsible.
Periodic office visits with or without X-rays may be necessary months later to ensure a patient’s well being. These may or may not be covered under your insurance plan. However, these may be required to monitor your health and healing .
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