Insurance - Frequently Asked Questions

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Are you in-network with my insurance?

We accept most insurance plans and are in-network with some insurance plans. If you wish to check our eligibility with your insurance plan, you may search for us under Madhuri Battula DMD

What will be my out-of-pocket cost?

Out-of-pocket costs include deductibles, coinsurance/copayment for covered services plus all costs for services that are not covered. If treatment is recommended, you will receive a treatment plan outlining our office fee, estimated insurance coverage and your estimated portion due. Our estimates are based upon information your insurance company has provided, and sometimes they do not provide complete details of your dental benefits. We always recommend obtaining a complete copy of your dental benefits from your insurance provider.

We do our best to provide you with an insurance estimation or can submit a predetermination to your insurance to determine the exact coverage amount. However, according to insurance, this is still not a guarantee of coverage or payment. Payment is subject to plan provisions and patient eligibility at the time services are actually incurred. Information shown may not reflect the most recent claims submitted for payment. Coverage may be different if your deductible has not been met, annual maximum has been met, or if your coverage table is lower than average. Please feel free to contact our office at any time to discuss your insurance plan.

What are coinsurance and copays?

Both are the portion of your dental treatment that you are required to pay. Copays are flat fees. Most dental plans pay a percentage for a benefit which is called a coinsurance, usually once you have met your deductible.

What is an annual maximum?

An annual maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific benefit period, usually a calendar year. Most plans have an annual maximum. Orthodontic coverage may have its own, separate, annual maximum.

What is a benefit period?

This is the time period within which your dental benefits are calculated. This is usually based on a calendar year (January-December).

What is coordination of benefits or COB?

When you have coverage under more than one dental plan, the plans will coordinate to ensure they don’t pay more than 100 percent of your total dental expenses.

 

 What is a deductible?

A specific dollar amount that you must pay before the dental plan begins to cover your expenses.

What is an explanation of benefits or EOB?

This is a document you receive from your dental insurance provider after you visit the dentist. It is not a bill, but rather an explanation of what procedures were performed and what was covered by your dental plan. Though EOBs vary across dental insurance companies, they should include the dentist’s fee, the portion insurance paid and any amount you may owe (such as deductible, coinsurance or non-covered services). It should also include an update on how much of your annual maximum has been used and the amount you’ve paid toward your deductible.

What are limitations or exclusions?

Because most dental plans don’t cover every aspect of dental care, each plan will have some limitations and exclusions related to type or number of procedures, number of visits or age limits. Check your plan booklet for specific details on your plan’s limitations and exclusions.

What is a pre-treatment estimate or predetermination of benefits?

For more extensive treatments, a dentist can request a cost estimate from insurance. This pre-treatment estimate will let you know in advance what procedures are covered and how much you will have to pay towards the treatment.

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