Financial Information and Frequently Asked Questions
What is a consult and why is it so important?
A consultation is not surgery. A consultation is done by many different professions prior to work done to evaluate a condition to find the best possible solution based on many tangible and intangible criteria.
In our surgical office, a consultation is important to complete to:
- evaluate the actual patient: their overall medical, surgical and psychological health to assess their ability to withstand and cooperate with the surgery intra-operatively, and 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
- you may receive more than one treatment option with the estimate cost breakdown to decide which is best for you
A consultation (speaking with each other and examination) is a very valuable tool to predict your surgery success and cannot be skipped.
Why am I given estimates, why not a hard number?
You have a maximum amount on your benefits, yearly.You have covered services and non covered services.When you see doctors for consults or procedures prior to visiting us, they use up those benefits.You may have pending claims that are not in your insurance “system” yet and our office will not have an actual amount of remaining benefits.Our office can only calculate “estimates” based on the information your insurance company has relayed to us on that day.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.You do not like estimates, and we do not like estimates, either.This is the process of insurance companies.
Why do I have to pay if I have dental insurance who claims to pay 100%?
Insurances companies design their plans to pay only a portion of the cost and you are responsible for the balance. Please read your insurance plan contract carefully.As a service, we do pre-estimates for you to help you in your decision, but even your insurance company will not guarantee that payment.Insurance companies do NOT cover all necessary services.There are covered services and non covered services.If a covered service is done, and your insurance company has not paid 100%, it is most likely due to you reaching your “max allowance”.
Understanding how insurance works is probably the most difficult part of it all.
In our office, we do not want surprises just as you do not want surprises and avoid unnecessary miscommunication. 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 and respect. We are so appreciative that you allowed us to serve you and we would like a smooth process from start to finish.
Also, an insurance company denying a service does not mean the service is unnecessary. For example, if a house has plumbing damage and the owner has a homeowners policy that does not have plumbing coverage, the problem will still need to be resolved.
Our fees are based on the national ADA fee schedule, are in accordance with our zip code and also pre-negotiated with your insurance companies for lower fees that benefit you, the patient.
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 necessary, quality treatment to you.
We have several forms of payment options available to help ease the burden:
- PPO Insurances listed below
- Discount Plans listed below
- Care Credit
- Lending Club
- We are in network with the dental PPO insurance companies listed below.
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Helpful Information To Plan Your Visit Wisely
Plan your doctor’s visits wisely when using insurance and know what your remaining benefits to date is.
Each individual has a different, specific plan and your insurance gives us an ESTIMATE of coverage for your procedure. The ESTIMATE given over the phone is not a guarantee. Dental insurance should be aptly renamed “dental assistance”. The agreement you have between your dental insurance and yourself does not involve our office. Your insurance agreement applies to any oral surgeon you use.
When our office calls your insurance, we do so to verify benefits remaining TO DATE, estimated percentage covered, your estimated payment, and their estimated payment. This is the information we relay to you, in writing, as of that date.
For example, if your insurance company states over the phone they ESTIMATE to cover 80% of your surgery but after the surgery is done sends the Explanation of Benefits (EOB) ACTUALLY covering only 60%, you are left with a balance which we collect from you which is very common for every healthcare office to deal with.
Please provide us with your medical insurance information when you register. We will need this information in order to obtain the medical insurance “denial” prior to submitting to your dental insurance. This is a formality which takes an average of 45 days that needs to be done otherwise it will lead to delays in processing your claim.
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 but offer a discount. if using secondary dental coverage, please be careful to assure that it is a dental PPO that we are in network in. 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 is extremely fortunate if your employer picks up part or all of your premium. It seems like a curse when they make you pay deductible, co this and that, because insurance companies were created solely to make 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 which is highly not advised as the treatment and costs escalate. This is the bane of all healthcare fields that prevents doctors from taking care of their patients in a timely, proper manner.
- We understand that oral surgery is not a want but an unavoidable need. It helps when you find that your oral surgeons, Drs. Hullett, are ethical, efficient, uses common sense as well as their expertise.
- 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”. It is calculated by practice expense, value of service and malpractice expense (aka, overhead within the zipcode).
- 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”.
These are rules that applies to any doctor, any dentist, any oral surgeon you see.
More on consultations…….
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 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.
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 unless other arrangements have been made in advance.
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 & Medicare AARP supplement
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