Insurance and Billing

Atlanta Oral & Maxillofacial will be happy to file your insurance claims for you. We accept checks, cash or credit cards and are happy to file insurance for your reimbursement.

Our Office Policy Regarding Insurance

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with you insurance benefits. By law, your insurance company is required to process each claim within 30 days of receipt. We file all insurance claims within days of treatment. We typically collect a co-pay at the time of your visit.  You are responsible for any balance on your account after your insurance company has completed processing your claim. If you have not paid your balance within 60 days following the completion of your insurance processing, a rebilling fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if your insurance pays us more than estimated from your co-pay.

PLEASE UNDERSTAND

We file insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment; we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance.

Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES

Insurance is meant to be an aid in receiving care. Many patients think that their insurance pays 90%-100% of all fees, this is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less, and the percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE

You may have noticed that sometimes your insurance company reimburses you or the provider at a lower rate than the actual fee. Frequently, insurance companies state that the reimbursement was reduced because your fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most providers in the area charge for a certain service. This can be very misleading and simply is not accurate.  As a general rule, our fees are competitive with the Atlanta health care community.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your provider is “overcharging” rather than say that they are “underpaying” or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure. Another trouble area is when Insurance Companies base their reimbursement on their own "fee schedule", which can be significantly less than the UCR.

Fact 3 – DEDUCTIBLES & PERCENTAGES MUST BE CONSIDERED

When estimating benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.