Patient Payment and Reimbursement

How Our Office Works with You and Your Insurance Company

• We know it’s confusing. We know it’s frustrating. So let’s take a moment to talk about this web of who owes who, and for how much…

  • Our office has a fee for every service we provide. For illustration purposes, at our office, “Procedure X” has a fee of $100. Without Insurance, a patient would have to pay $100 for “Procedure X”.

  • When our office accepts to be in-network with a dental insurance company, we agree to see patients with this insurance policy at a reduced fee.

  • So if you have “Insurance Company A”, and our office is in network with “Insurance Company A”, we can not charge our usual fee for “Procedure X” at $100, rather we agreed to perform “procedure X” for let’s say, $50. This reduced fee varies from insurance company to insurance company.

  • So now our office will only be paid $50 for procedure X. That is our Contracted Rate.

  • Now YOUR contract with insurance company states that, for “Procedure X”, they will cover 75% of the contracted rate of $50, and you, the subscriber, will be responsible for the remaining 25% of that $50.