If you have Dental Insurance:

In order to provide an estimate of your out-of-pocket costs we will need your insurance information – if you have a secondary insurance we will need that information as well. YOU are responsible for providing your insurance information. We do not usually receive that information from your dentist.

Primary member – this is the person who is the main subscriber for the plan, generally through your employer. Many times you are the primary but not always. If the insurance primary subscriber is your spouse / parent / partner we will need their complete information as well as yours (Dependent) for all insurance plans.

1. Name of Dental Insurance Company with phone number (usually found on the card front or back)
2. Primary subscriber: Complete Name (this is the person subscribed to the dental insurance plan first).
3. Primary subscriber: Date of Birth – month, day and year
4. Primary  Dental Insurance ID number (or SSN) – not the group #
5. Primary: Zip code of residence
6. Patient  (if Dependent): Name and Date of Birth

When possible we will verify your insurance and only charge the estimated patient portion at the time of service. Not the full amount.

Please keep in mind that there are no guarantees of insurance coverage as the information provided to us by your insurance company is limited.  Some plans have MAB (Maximum Allowed Benefit) and they will not provide that information prior to our billing.  Sometimes there are outstanding claims that will effect your annual maximum or frequency limits that we cannot see until they clear.

For example an Exam charge is $151 – the insurance pays 100% but the MAB (fee schedule) is $45 – your out-of-pocket cost will be $106.
For example an Exam charge is $151 – the insurance pays 100% but the frequency is limited to 2 visits per year, and you’ve already used those. They will pay $0.00.

If your plan has a ‘Fee Schedule’ or ‘Maximum Allowed [MAB or MAC]’ chances are they will not tell us what that is. We can submit for a pre-authorization claim but that can take 30+ days and is still not guaranteed. It is usually a good indicator of what they will cover and some insurance plans will process this within a few days-weeks. I maintain a spreadsheet of what different plans/companies allow – while not perfect it is helpful with estimating our out-of-network plans.

We are In-Network with Delta Dental all states.
We are a Delta Premier and PPO / EPO provider.

We are Out-of-Network for all other insurances. Metlife, Ameritas, GEHA, Pacific Source, Aetna, etc

We cannot bill DeltaCare / OHP / Jackson Care / Medicare / Kaiser Dental Insurance as they require in-network participation. We cannot bill any insurance that requires contracted participation other than Delta Dental. In some cases you can get a waiver to see us (see below for more information).

Verify your out-of-network benefits!
Depending on how your specific plan is set up the benefits may be the same for In & Out of network, or they can be very different!

For us to be able to bill your insurance plan you would need to have Out of Network benefits available (except for Delta Dental as we are in-network).  If your plan requires a participating provider we cannot bill your insurance. If you are unsure please contact your insurance company directly or call us and we can help. Most insurance companies have a website you can log into and search for in-network providers as well as review your plan documentation. That said, most endodontic specialists in Southern Oregon and Northern California are out-of-network.

You will need to provide your insurance information to us prior to your appointment / treatment. Please provide (in person, fax, email) a legible copy of your insurance card [front and back], Primary Member (you, spouse, parent, etc) Full Name, Date of Birth, Insurance ID number or SSN (if that is what your insurance uses), zip code and the same information for the patient if they are secondary. If we are not provided with this information, or the information is incorrect, we will bill you as a cash patient and we can provide an itemized statement for you to get reimbursement directly from your insurance company.

Insurance TIP!

If your insurance requires In-Network participation, but there are No In-Network providers within a reasonable range, you may be able to get an authorization from your insurance company to go to a provider Out of Network for the same coverage. You would need to call your insurance directly (we cannot do this for you) and ask them to help you find an in-network provider. When they prove to themselves there are no providers in a reasonable distance ask for an authorization number or letter (get it in writing if possible) allowing you to go out of network (at in-network prices). This doesn’t always work but it’s worth a try.