Insurance and Financial Information

Modern Dental Office in DCWe understand that effective communication is essential when dealing with healthcare expenses. We are happy to discuss our professional fees with you at any time. Your clear understanding of our Financial Policy is vital to our professional relationship.

Your estimated payment is due and will be collected upon the start of treatment.

Upon leaving our office, you will be provided with a statement of charges and payments for the day. After your insurance has reimbursed us for the treatment, you will be billed for any portion remaining or unpaid by your dental plan.

We realize that everyone’s financial situation is different. For our patients’ convenience, we have worked hard to provide a variety of payment options to help you receive the dental care needed with respect to your finances. We could give you some payment options that may suit your need.

We accept:

  • Cash
  • Checks, Money order, Traveller’s checks
  • Mobile and contactless payments: Apple Pay, Samsung Pay, Android Pay
  • All major credit cards: Visa, MasterCard, Discover, American Express
  • Financing options are available through third-party financing companies, such as CareCredit and Lending Club Patient Solutions (subject to credit approval, terms and conditions may apply). Please note that we do not endorse any third-party financing company.  Please make sure you understand the terms and conditions of the financing if you decide to use any third-party financing options.

Using HSA or FSA

You can use your HSA or FSA account at our practice for eligible dental treatments, and we will provide you with detailed itemized statements for your records.

For Self-Pay and Uninsured Patients

You may enroll in our Washington DC Dentistry Dental Saving Program where members enjoy covered preventive care and have access to all additional treatments at discounted rates without any exclusion. It is NOT a dental insurance plan. It is our in-house dental saving program to help our self-pay patients.

Insurance

Regardless of your dental insurance coverage, you are welcome at our practice. That means even if you are uninsured or underinsured, we would love to see you as our patient.

Washington DC Dentistry will accept and work with any PPO dental insurance and indemnity plans. As long as your dental plan allows you to choose a dentist of your choice, you will receive benefits at our office. Our team will help you understand your particular plan, outline the benefits, and maximize how they can be utilized. We are happy to provide a courtesy insurance eligibility check for you to see how much estimated coverage you will receive at our office. We will also be glad to help you with submitting claims to your insurance carrier.

How Your Insurance Works

Dr. Kham Reviewing Dental XrayThis FAQs section explains how we will help you with your dental insurance and how it works at our practice. We encourage you to read it carefully.

We will help in every way we can to maximize your benefits. If requested, we will obtain your insurance coverage estimate for you. You are encouraged to contact your dental insurance carrier directly if you need more information than what we can provide to you. After all, insurance is a contract between you (your employer) and the insurance company.

What is my coverage level?

It varies greatly. Your benefits and coverage level is determined by the premiums you (your employer) pays. i.e., the higher the premium, the better the benefits.

Does my insurance cover the treatment I need?

Your dental plan does not always cover what you need to maintain your optimal health. Many dental plans have exclusions and a list of uncovered services.

You can be assured that our professional services are recommended and provided for you based on your health needs, not on your insurance benefits coverage. We will not advise a treatment just because you have coverage for it. In other words, our treatment recommendation is independent of your insurance benefit.

What is annual maximum coverage?

This is a set amount of dollars you get every year from your dental plan for covered treatments. Your plan will not pay any more when you reach the maximum coverage for a policy year.

What is a deductible?

This is the amount you pay before your dental plan kicks in. As a general rule, you pay a deductible only once a policy year.

What is co-payment or co-insurance?

This is the amount you pay out of pocket for every procedure. It is also the amount you are expected to pay our office at the time of service. For example, preventive services such as cleanings and check-ups usually do not have co-payments and are covered 100%. Basic services, such as fillings, are generally covered 80%, which means you pay 20%, and your plan pays 80%. Major services, such as crown and implants, are usually covered 50%, which means your insurance pays 50%. It is important to note that some insurance carriers pay fixed allowances for certain procedures, and others pay a percentage of the charge.

What is UCR? Why are your office fees higher than UCR?

Usual, Customary, and Reasonable Charges is a term developed by insurance carriers. It represents ” average charges” set solely by an insurance company for a specific service provided in a geographic region, regardless of the office facilities, doctor’s education/training, patient experience, and level of service. UCR is different from the actual fees charged by your dental office. Each insurance carrier has its own UCR fees, which is always lower than your dentist’s actual bill.

It is essential to understand that when insurance pays 80%, it is the 80 % of their set UCR schedule or Maximum Allowable Charges, not what we charge. Depending on your dental plan benefits and our office relationship with your dental plan, you may be billed the difference.

Why did my insurance downgrade my treatment?

If more than one option is available, your dental plan almost always pays for the cheaper treatment option. For example, your white filling may be downgraded to a silver filling and paid as a silver filling. Your crown and bridge may be downgraded and paid as a denture. In that case, you will be responsible for the difference between the costs. Please reference your plan brochure or contact your insurance carrier if you have a specific question.

Can you tell me how much my treatment cost is?

We are always upfront with our fees schedule. Our office fees do not change once presented to you. How much you pay varies depending on your benefit level and how your insurance processes the claims. It is not possible to know the exact number until your treatment claim is filed and processed. Again, we will try our best to give you accurate estimates based on the information we receive from your dental insurance carrier.

What is pre-authorization? My insurance told me to get it before the treatment.

According to healthcare.gov, “It is a decision by your health insurer or plan that a healthcare service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require pre-authorization for certain services before you receive them, except in an emergency. Pre-authorization is not a promise your health insurance or plan will cover the cost.”

We DO NOT routinely submit pretreatment authorization. It is not in line with our philosophy to provide the best possible care to our patients. We firmly believe patients should make the informed treatment decision for themselves based on the treating dentist’s recommendations.

How does the claim process work? How long does it take to hear back from my insurance?

It usually takes 2-6 weeks for your insurance company to process the claim once we have submitted it for you. We submit the claim for you the same day we finish your treatment, together with all necessary information such as treatment narrative, supporting x-rays, and pictures.

GENERALLY, three things may happen after we have filed the claims for you:

  • Your dental plan pays as we estimated.
  • Your dental plan downgrades/reduces the benefit. You will be responsible for the difference.
  • Your dental plan rejects/denies the benefit. We will file an appeal on your behalf with all necessary documents. This is a courtesy service we provide without any cost to you. You may also contact your dental plan directly or get your HR involved to resolve the issue. If your dental plan does not remit payment, you will be responsible for the remaining unpaid balance.

Insurance claims for your carrier are filed as a courtesy at no charge to you. Please let us know if there are any changes to your insurance. It is your responsibility to provide us with information relative to your claim, including; insurance ID number, group number, employer, date of birth, and other related information. This information is requested on the patient registration form.

Call us at (202) 677-0456 with any questions!