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Financial & Insurance

financial-formsWhat are my payment options?

Orthodontic treatment is an excellent investment in an individual's health and well-being. Because of this, we believe financial considerations should not be an obstacle to obtaining this procedure. Being sensitive to the fact that different patients have different needs, we provide the following payment options:

  • Low Monthly Payment / No Initial Payment
  • Pre-payment Courtesy
    A prepayment courtesy of 5% is given for payment in full prior to treatment by cash or check or credit card.
  • Initial Payment Plan
    A down payment of approximately 25% is made at the start of treatment, with the balance paid monthly over approximately 24 months of the treatment time. We accept cash, check, and credit cards for the Initial Payment Plan.
  • Company Flex Plan
    Your company may offer a medical spending account, which allows you to set aside pre-tax dollars to pay for your medical expenses. Please contact your employer for more details.

Insurance Coverage

Our practice will be happy to assist you in determining whether your insurance company will cover your orthodontic treatment. If your company does provide a benefit, our team will take care of filing your paperwork.

Please feel free to contact our practice to discuss any of the options listed above and to continue reading below for more information.

Insurance Facts

As we work with you to create your wonderful new smile, we understand that part of this process includes financial considerations. At Furino & Hamlin, we strive to give you outstanding treatment results, while utilizing your insurance coverage and other benefit plans effectively.

There are literally hundreds and hundreds of types of orthodontic coverage depending on what your employer purchases. Policies for orthodontic treatment can at times make determining your benefits difficult. Below are a few key questions to ask your insurance company when determining what your coverage will be. Please keep in mind that, if you are coming to see us for an initial visit, we will be checking on your insurance benefit for you.

  1. Do I have orthodontic coverage associated with my dental insurance?
  2. If I do have orthodontic benefits, what is the lifetime maximum payable?
  3. What kind of fee schedule is used to pay out the benefit?
  4. Is there a deductible that applies to orthodontics?
  5. Is there an age limit pertaining to orthodontic benefits?
  6. Can the benefit be assigned to (paid directly to) the dentist?

Predetermination

Once treatment is recommended by our doctors, we can then submit a pre-determination to the insurance company. This is basically an overview of our proposed treatment plan, and it provides the insurance company with several pieces of key information including the doctors clinical findings, total treatment fee and approximate length of treatment.

After the insurance company processes the predetermination, they often respond on paper with an Explanation of Benefits (EOB) form. This actually states in writing the benefit the insurance company expects to pay for your treatment. As with the actual insurance benefits themselves, EOB’s can come in a variety of formats and some are easier to read than others. At this time, if you have questions about what is or isn’t covered, you can either call your insurance company directly, or you are always welcome to contact us for additional information.

Usual and Customary Rate (UCR)

The most confusing element insurance companies use is what they call UCR. UCR is referred to by insurance companies as Usual and Customary Rate. Many times your coverage is based on a percentage of UCR. UCR is NOT a reflection of the usual fees for dentists in your area, but rather is a maximum fee that the insurance company is contracted to pay. The confusing part arises when an insurance policy says it will cover 100% of a particular treatment, only to find out that in fact that is not so, because it actually refers to 100% of UCR, which is not usually the dentist's fee. Typically UCR is anywhere from 10% to 40% lower than actual fees for an area.

More Than One Insurance Policy

For clients with coverage from more than one insurance policy, there are general rules designated by your respective insurance companies for how to manage payment with the different policies.

Primary and Secondary

In general, if there is a primary insurance and a secondary insurance, the policy that is primary is the one to which you are the subscriber. A secondary policy is one where you are covered under someone else's policy. These are not choices you can make, but rather determined by your insurance company.

Dependents

The designation of which policy pays first for dependents again depends on the rules of your insurance company. The typical rules for dependents of parents not separated or divorced with overlapping coverage rely on birthday of the parent, gender of the parent, or some other rule. For divorced/separated parents, specific custody rules usually apply, unless some specific arrangement is agreed to by each party. These designations are unique to each particular insurance.

When does secondary pay?

Usually, the secondary policy will not usually accept a claim until after the primary claim is paid, and then the secondary policy will often require a copy of that payment information (referred to as an EOB, explanation of benefits).

*Based on a loan with an 8.9% APR for 60 months. Terms of the loan may vary based on the treatment fee and credit information. All figures are estimates.

Furino & Hamlin Orthodontics

  • Furino & Hamlin Orthodontics, P.C. - 1 Paris Rd., New Hartford, NY 13413 Phone: 315-724-5800

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