If you think the treatment you need and the treatment your dental benefits will pay for are the same things, think again. They are by no means necessarily the same! We consider payment for the dental treatment that we deliver to you as your responsibility and that any dental benefit payments that may be expected for you as a matter between you and your carrier. That said, we make an attempt to learn from any benefit provider with which you may have coverage the basic details of your plan and what can be expected for reimbursement from that plan. Virtually all dental underwriters stipulate that benefits are only paid towards "usual, customary and reasonable" fees (as established through the plan) and that they will not guarantee payment of any
We will do the best that we can with the information made available to us by your claim for our services rendered to you over the phone. No benefit company that we have heard of has been willing to disclose how they presume fees to be "usual, customary and reasonable".
dental plan(s) to determine what their reimbursement for our services will be. We will also submit accurate and complete benefit claim forms to your carrier(s) for the greatest reimbursement of those services allowable by your underwriter(s). Please be aware that if you have dual coverage (are covered by more than one plan), as could occur when your spouse also has coverage that may include family members, a process known as coordination of benefits comes into play. In this scenario, your employer's plan is considered your primary coverage and your spouse's plan (if it also covers you) is a secondary benefit. In all instances, under the coordination of benefits process, secondary coverage will still leave you some (though most times less) of an out of pocket expense after reimbursement by both plans.
If an appeal becomes necessary on a denied claim, Dr. Roden will be happy to furnish any additional information that may be requested concerning your treatment, either over the phone, in writing or with portions of your record (such as If any claim processed for your treatment is denied, it is your responsibility to pay us this amount in full. It is also in your best interests to look into the matter yourself because it has been our experience that dental benefit companies are far more responsive to their clients (your employer and you, the employee/dental patient) who pay their premiums than they are to the dentists who are creating claims they are expected to pay.
x-rays, for example). If you have any questions about the typical course of dental benefit claims, or possible alternatives to traditional plans, please ask us.