How much is this going to cost?
Fees for root canal therapy are determined by tooth type, previous treatment and the complexity of the case. Although each case is individually quoted, fees generally range between $700 to $1700. The fee commonly includes:
- Emergency treatment (during office hours)
- Prescriptions (written)
- Health history and physician’s consultations
- Instrumentation and cleaning of the root canal
- Filling of the root canal
- Placement of temporary outer filling
- Reports to your general dentist, insurance carriers
Examination, diagnosis and treatment plan including diagnostic testing and all necessary x-rays are charged at separate fees. Additional procedures, i.e. surgery, consultations, after hours visits, etc. typically invoke additional fees.
What is your financial policy?
Fees are based primarily upon the type of tooth treated (molar, bicuspid, incisor) and whether treatment is initial or a re-treatment. All fees are based on clinical requirements and are not influenced by the method of payment or presence of insurance. For those patients without dental insurance, payment is due in full at time of service. Payment can be made in the form of cash, check, MasterCard, Visa, or Discover.
I have dental insurance, so I don’t have to pay anything, right?
Please note insurance plans rarely cover 100% of your treatment costs. Most plans claim to cover fees at 80%, yet due to many factors (UCR, Co-Pays, maximum annual benefits, etc.) the actual dollar amount may be closer to 66% or less. Because of this, patients with insurance are requested to pay 1/3 of the treatment fee at the time of service. Payment can be made in the form of cash, check, MasterCard, Visa, or Discover.
Dental insurance has been a wonderful means by which people are able to afford the dental care they require. As a courtesy to you, we will submit you dental insurance claims. However keep in mind that dental insurance is a contract between you (the subscriber) and the insurance carrier. As we have no control over your insurance carrier’s method or amount of payment, all financial responsibility for incurred fees is ultimately yours.
In order for us to accept your insurance, the information must be complete and verifiable. Outstanding insurance balances of 90 days will be billed to the patient regardless of coverage.
I have Delta Dental, is that different?
Presently Dr. Moyer is a Delta Dental Premier Provider. This allows Delta Dental to pay our office directly on your behalf. Whenever possible, our staff will attempt to determine your specific portion due at the time of service. Ultimately the patient assumes responsibility for any assessed fees.
Does Dr. Moyer accept my insurance? Is Dr. Moyer in my network?
Your referral to our office is based on the confidence your Doctor has in our knowledge, skill and compassion to provide you the best possible endodontic care. Patients are not referred to us because we are “in their insurance.” Currently our office does not participate with any HMO’s PPO’s, managed care plans or networks.
Although Dr. Moyer may not be listed in your plan, we do work with and accept the majority of insurance plans. Most insurance plans even those with Preferred Provider Options (PPO) allow benefits to be paid on an “out of network” basis. The amount the insurance actually pays is typically the same for “in” or “out” of network providers. The difference is the amount you are responsible for. An “in network provider” has signed a contract whereby they agree to accept a discounted fee.
It pays to know the limitations and restrictions of your insurance plan. We suggest you contact your insurance provider or benefits coordinator to find out the specifics of your plans’ coverage.
*Presently Dr. Moyer is a Delta Dental Premier Provider
What is “UCR” and how is it determined?
“UCR” is a term coined by insurance companies to describe the amount they are willing to pay for a particular procedure. Technically it means; Usual, Customary and Reasonable inferring that there is some honorable system of what Doctors should charge for a given procedure. Unfortunately there is no standard fee or accepted method for determining the UCR. UCR levels vary from insurance company to insurance company even for the same geographical region. By law, fees must be charged independently of what insurance companies pay or what neighboring practitioners charge.
How do I know what my payment portion will be?
Whenever possible we will attempt to determine the specific benefits available to you. With so many insurance companies having interactive websites and 800# customer service centers, we are often able to determine your exact financial responsibility. This is why it’s so important you bring your current insurance information with you to your initial appointment. When we are unable to verify the specific amount, we rely on past experience. Historically most insurance companies cover approximately two-thirds of our fee. We will submit the claim for you and request an estimated patient portion (about 1/3) be paid from you upon completion of treatment.
What if the insurance company pays more than 2/3rd of the fee. Will you reimburse me?
Yes, unlike some general dental practices we do not keep balances on account. Should the insurance company pay more than we expect, we will refund you. Likewise, if they pay less than expected, we will bill you at that time. Refunds are automatically processed on the 15th and 30th of the each month. There is no need to request a refund; however, you may make an inquiry of your account at any time.
Are root canal treatments generally a covered benefit?
Yes. Typically most dental insurance policies have provisions to cover root canal therapy (Endodontics). Coverage can vary, but generally benefits range from 50% to 80%. Certain plans can have restrictions as a way to reduce their costs. Your plan may not include a particular treatment or procedure although your Doctor deemed the treatment necessary. Please keep in mind that there are many insurance plans available and that your employer chooses your plan and your benefits. If you believe your benefits are inadequate, you may want to discuss the matter with your plan administrator and explore appropriate alternatives.
It pays to know your insurance.
Why was my benefit different from what I expected?
Dental insurance is a contract between you and your insurance carrier and ultimately it is the patient’s responsibility to know their insurance coverage. Several factors can be responsible as to why a procedure was denied or paid at a reduced rate. Common reasons include:
- You have already used some or all of the benefits available in a given year
- Your insurance plan paid only a percentage of the fee charged UCR limitations
- The treatment you needed was not a covered benefit Treatment Exclusions
- You have not yet met your deductible or you have a high Co-Pay
- Frequency of treatment limitations
- Waiting or eligibility periods
- What if I still have questions?
Whenever possible we will attempt to determine the specific benefits available to you. On occasion a pre-treatment estimate (pre-authorization) can be sent to your insurance company to verify what they will cover. Because the need for root canal therapy can be urgent, most insurance policies typically do not require any special pre treatment authorization. We will do our best to answer your questions and advocate on your behalf. Direct contact by you, the insurance subscriber, is the best was to understand and maximize your insurance benefits.