Financial Information and Frequently Asked Questions
What is a consult and why is it so important?
A consultation is not surgery. Done by many different professions, a consultation is necessary to evaluate a problem to find the best solution, which is based on many tangible and intangible criteria.
In our surgical office, a consultation is important to:
- evaluate the actual patient for their medical, surgical, physical and psychological health
- to assess their ability to withstand and cooperate with the surgery intra-operatively
- assess the patient’s ability to cooperate with post-operative instructions
- request other specialty (ENT) or medical consultation (Cardiac) to do their own evaluation PRIOR to us doing invasive surgery which carries it’s own inherent risk
- to evaluate which procedure and anesthetic techniques would best serve you
- form treatment option(s) with the estimate cost to decide which is best for you
It is important to note that the only person who can determine the “codes” is the surgeon, as these are diagnosis codes, directly related to the exam and diagnosis. Also, our coding is done ethically and can stand the test of time.
A consultation (speaking with each other and examination) is a very valuable tool to predict your surgery success and cannot be skipped.
What is insurance?
Insurance is “payment assistance” for your healthcare. Insurance is purely a business. Insurance is not a doctor, they cannot make recommendations or prescriptions and they cannot dictate ethical treatment.
One way or the other, you are paying a premium TO THEM in order to obtain insurance, even if you never use it.
We are not in network with Medical Insurances, CHIP, Medicare, Medicaid or HMO’s.
We are in network with PPO Dental Insurance, a list is below.
When using PPO Dental Insurance:
Why am I given estimates, why not a hard number?
Us: Our office has voluntarily agreed with your dental insurance to take a lower payment for your service.You: Know your insurance policy, in detail because this is what makes up your estimate.Know your start and end dates.Know your maximum yearly benefits and remaining benefits.Know your deductible, which is the money you must pay to your insurance before they consider paying for your oral surgery work.Know what is covered and not covered.Know if your dental coverage is embedded in your medical insurance (which is a red flag — because your out of network medical deductible must be met before they even consider covering your dental work. Some medical deductible’s are very high!)..When you see other doctors for consults or procedures prior to visiting us, you use up those yearly benefits.You may have pending claims by these other doctors that are not in your insurance “system” yet and our office will not have an actual amount of remaining benefits. Our office is not privy to prior work you have had done with other doctors, but the only one who has the most up to date knowledge is you.Our office can only calculate “estimates” based on the information your insurance company has relayed to us on that day.You do not like estimates, and we do not like estimates, either.This is the process of insurance companies. Remember, you pay them! Pick an insurance company that makes sense for your lifestyle and budget.
Why do I have to pay if I have great dental insurance who claims to pay 100%?
In twenty years of being in this field ourselves and our 30+ year veteran insurance billing employee who tirelessly handles all claims and appeals on your behalf, we have never seen any insurance company pay 100% and you $0 for service.Insurances companies design their plans to pay only a portion of the cost and you are responsible for the balance. Please read your insurance policy carefully.As a courtesy, we do pre-estimates for you to help you in your decision, but even your insurance company will not guarantee that payment, and they will even write that it is not a guarantee at the top of the Pre-D document (your insurance has mailed a copy to your home address).
Why did my medical insurance deny the service and now my dental will not pay either:
Know your insurance policy, know what you are signing up for!
We can only tell you what your insurance tells us and they will start the conversation by saying “This is not a guarantee”.
Your employer signs you up with Blue Cross and Blue Shield Medical Insurance.
They tell you it comes with an embedded Dental Insurance plan.
Sounds great! Just one premium right?
(Look at the fine print, look at your deductible which is how much you need to pay out of pocket BEFORE your insurance will consider paying).
Now you need oral surgery (not that you want it, but you need it).
No matter what private practice oral surgery office you go to, it is all the same.
You fill out our forms to tell us what your insurances are and then we contact the insurance company to find out your benefits. They will tell us what your information is.
Remember, we know we are not in network with any medical insurances — no private practice oral surgeon is.
When our office calls to verify your benefits and they tell us we have to BILL MEDICAL FIRST, the claim (the charges) MUST be sent to medical as a formality.
Three things can happen at this point that will effect your claim.
1) medical will deny the claim because there is no oral surgery coverage and now with that denial document, we can file the denial to your dental insurance who can now review the claim.
2) you have oral surgery benefits in your out of network medical insurance BUT you have not met your out of network medical deductible. Medical will apply the amount charged to your deductible therefore, Dental insurance will not pay either because the deductible has not been met (for an embedded medical/dental under one insurance plan).
3) you have oral surgery benefits in your out of network medical insurance + you have met your out of network medical deductible, your medical insurance has reviewed the claim and they will pay a portion. The balance is your out of pocket responsibility.
The medical or dental insurance policy that you or your employer has chosen is between you and them.
Tiring, right? And there is so much more! Bottom line is, we try to protect your health as much as we can, give you the correct information, and be properly paid for our service.
Understanding how insurance works is probably the most difficult part of it all and it is especially hard to deal with when you are in pain.
Where did we get our fees from?
Our fees are based on the national ADA fee schedule for Oral and Maxillofacial Surgeons and specifically our zip code.
There are 6 domains of healthcare quality that our measure themselves by in order to keep our costs down. Are we: Safe, Effective, Patient-Centered, Timely, Efficient and Equitable? Drs. Hullett holds themselves up to these measures and will recommend and provide only necessary, quality treatment to you. You should be able to hold our treatment plan up to any other surgeon’s treatment plan and be satisfied.
In our office, we do not want surprises just as you do not want surprises and avoid unnecessary negativity. You will receive complete and written information regarding our office policies. We work very hard to maintain a peaceful, simple and honest healthcare service business for our community. Good business is essential to longevity, respect and our own personal peace.
We are appreciative that you have chosen us to perform your surgery and anesthesia.
Have Confidence in Your Smile! Get in Touch Today
We are a family owned private office where we will get to know you, we care about your over all well-being, and we use our experience and judgement to give you excellent results.Make an Appointment
Please call our office at our main number, 713-439-7575 during office hours. Confusion can be cleared up with proper communication. Our staff is educated and here to help you.
Insurance Terms To Know and Tips To Beware Of:
Medicare Coverage and Secondary Coverage: We are not contracted with Medicare. If using secondary dental coverage, please be careful to assure that it is a dental PPO that we are in network with. The insurance companies are not always forthcoming when we verify your benefits, and sometimes do not give us the correct information either. We do not want you to get stuck with a larger than normal patient portion bill.
Insurances that claim to cover 100% of the covered services: We have yet to see this miracle happen. We advise you that after your consult with us, take your time in investigating your own insurance company that they will follow through or request a pre-estimate, which they also do not guarantee payment.
Birthday Rule: The primary subscriber is the adult with the birthday earlier in the calendar year.
Age 26th Birthday: Under current law, you will not be covered under your parents coverage when you turn 26. For example, AETNA will claim that you are still covered until the end of the month (verified by a rep call AND on their website, however, they will deny the claim because they ACTUALLY terminate your coverage on your 26th birthday.
Waiting Period: The time, usually 6- 12 months, your new insurance will have you wait until some or all your benefits become active.
Missing Tooth Clause: When your current insurance will not pay for an implant if the tooth was extracted prior to your current insurance coverage.
Your Contracted Amount (if present): The insurance has negotiated a reduced fee for participating dentists. The negotiated amount is printed in this column if the health care professional is a participating dentist, otherwise zeros will appear.
Amount Eligible for Coverage by the Plan: Part of the “Your Contracted Amount” eligible for coverage under the plan. This amount is used to help calculate how much will be paid by the plan.
Remaining Balance: “Amount Eligible for Coverage by the Plan” minus “Patient Deductible” TO DATE
For example, if you visit multiple dentists or oral surgeons (for second opinions, etc) within a certain time frame, it is very likely they are charging your insurance using up your benefits.
Plan Covered ($ or %): The amount of the “Amount Eligible for Coverage by the Plan” paid by the plan.
Premium – The monthly payment you make to have insurance.
Co-Pay: The flat fee amount you agreed with your insurance to pay out of pocket for each visit.
Deductible: The amount you agreed with your insurance to pay out of pocket before the insurance starts to pay (typically does not include co-pays).
Co-Insurance: After your deductible is met, it is the % of the coverage you pay out of pocket.
Out of pocket maximum: The most you can pay for covered dental expenses in the covered year.
- Is having insurance a blessing or a curse? When you need healthcare services or at higher risk for services, it is a blessing. It seems like a curse when they make you pay deductible, co this and that, because insurance companies were created solely to hold you accountable for your health status and life habits. Patients will mistakenly allow their insurance to dictate their treatment as well.
Example: You come in with a painful, active infection today requiring immediate treatment, but your insurance does not cover the procedure until it turns over 4 months later because you have used up your benefits, so you choose to wait. This is highly not advised as the painful tooth may turn into a spreading abscess which is costlier to treat down the road, not to mention — unsafe.
This is the bane of all healthcare fields that prevents doctors nationwide from taking care of their patients in a timely, proper manner.
- We understand that oral surgery is not a want but an unavoidable need. You will find that Drs. Hullett, are ethical, efficient, uses common sense as well as their expertise to help you.
- Doctors who are in network take an agreed upon reimbursement. Insurance reimburses the doctors based on zip code (geographic index) and RVU’s. RVU is “Resource Value Units” aka overhead costs within the zip code (and this number is based on the Medicare business!).
- Doctors are ethically and lawfully bound to never overcharge if your insurance covers a portion of your service.
- It is also unethical and illegal for doctors to charge only the insurance and not you, “just to get your business” as well as put the incorrect date of service on your claim.
These are rules that applies to any doctor, any dentist, any oral surgeon you see.
More and more…..
We are often questioned why we need to do a consultation before we do invasive surgery if you already saw your dentist in their office and should just do what the referral paper says.
At your consultation, the surgeons review your medical history, surgical history, general anesthesia history, medications, allergies and consult with your medical doctors if necessary. We perform a clinical exam and an xray/CT scan review to study the anatomy to determine certain measurements and risks that can only be done in person. We do this in order to have a complete and appropriate face to face conversation with you to tailor your treatment for the best outcome, pre-, intra- and post-op and management. We need to determine if you will be safely treated in our office setting or need an OR/Hospital setting. You will receive all of your paperwork and prescriptions and are free to ask any questions at this time.
If an internal medicine doctor referred a patient to a cardiac surgeon to operate on the heart, the cardiac surgeon definitely needs to see the patient for a consultation!
At your consultation, we will gather your insurance information and call them for your benefits prior to any surgery. Based on the information they provide us, you will be given a written plan outlining the prescribed procedure and itemized cost for your review. There should be no question or doubt of what service you are paying for.
Once surgery is completed, we submit your claim to the insurance company on your behalf. This assures that the correct code and exact surgery done is submitted.
Most insurance companies will respond within four to six weeks and we mail you a monthly statement. Please call our office if your statement does not reflect your insurance payment within that time frame.
Balance: Any remaining balance after your insurance has paid is your responsibility. Your prompt remittance is appreciated.
Credit: If you have paid your portion of surgery and the insurance company has also paid, you will be mailed a patient refund. It is important we have an accurate address on file.
If you desire a pre – estimate with your dental insurance, we will be happy to do it for you and this takes about 4-6 weeks for a result from the insurance company.
For your convenience we accept checks, Visa, MasterCard, Discover, Amex and financing through Care Credit and Lending Club.
We deliver ideal and ethical care using the ADA National Fee schedule which is based on RVU cost guidelines for our zip code in Houston and Sugar Land. Payment is due at the time service is rendered.
We are in network with these Dental PPO insurances:
- Assurant PPO/DHA
- Blue Cross & Blue Shield Anthem/Unicare 100, 200, 300
- Boon Chapman
- Cigna Dental
- Delta Dental
- GEHA / Connection Dental
- Lincoln Financial
- United Concordia
- United Healthcare
We are in network with these Dental Discount Plans:
- AON Dental
- Care POS
- Signature Dental Discount Program soon to be known as Benefits Services of America