2700 W Anderson Ln #418, Austin, TX 78757                                                                                                                                       

                                                                                                                                       (512)334-9894

DENTAL INSURANCE

How Insurance Works

Insurance has two major benefits for the patient: a discounted price on services (resulting in a lower out of pocket), as well as offering to cover a portion of the cost of services rendered. When we are in-network with your insurance provider, you are able to utilize the maximum benefits

 

The way our estimations work are based on your insurance's in-network discounted fees. So those are a fixed cost for you, but they can vary each year based on our negotiations with your provider, which may account for different quotes over a number of years. And every insurance company sets their own fees, so if you change insurance companies, the prices will change.

 

Your out-of-pocket responsibilities can vary according to your annual deductible, your annual maximum, and how much of that maximum you have left for the current plan year. This affects how much insurance will pay for your procedures.

 

So, for example, if you have $100 left in your maximum, and insurance would normally cover $200 for a procedure, they would only pay the first $100 and you would be responsible for the $100 they didn't cover PLUS your normal out-of-pocket co-insurance. So if you’ve used your benefits at other offices or specialists, the information provided at the time we plan out your treatment may not be completely accurate due to annual maximum usage.

How We Can Help You

Initial Verification: We want to make things as easy as possible for you to enjoy your trip to the dentist, so we try our best to understand your insurance coverage before your visit with us. We ask that you fill out your forms beforehand (find forms HERE) so that we can verify your insurance & benefits before your visit. This can help cut down on wait times when you arrive.

 

Approximately 48 hours before your appointment, we will use the online portals provided by your carrier or, if the information is unavailable, we’ll work our way through the automated system to speak to an insurance representative to understand the following:

 

1) Your annual maximums & deductibles

2) Your coverage percentages for Diagnostic & Preventive, Restorative, Periodontal, Endodontic, Oral Surgery, Crowns, and Orthodontic services

3) Allowable frequencies

 

We then apply your carrier's discounted fees to the treatment plan, which updates the total cost & estimated coverage percentages.

 

Claim Submission: After we submit claims to your insurance carrier, we work with them to provide more information, x-rays, and narratives to ensure the best possibility of pay-out. If we receive denials of coverage for services that weren't due to frequency, annual maximums, or non-covered services, we will send an appeal on your behalf to encourage their payout. We fight to get you as much as coverage by your insurance as possible.

 

However, if insurance continues to deny our appeals, the balance on the account is the responsibility of the patient.

 

Patient Responsibilities

We ask that as soon as your updated insurance information is available, you pass it along to us so we can update your treatment fees (which affects your estimations). A phone call is the quickest way to get the information to us, but please feel free to email it to us using the contact form. The following information is usually required to verify your insurance:

 

  • Insurance Carrier:

  • Subscriber's Name:

  • Subscriber's Date of Birth:

  • Relationship to Subscriber:

  • Member/Subscriber ID/SSN: (For Metlife patients, your social security number is REQUIRED for the fastest verification)

  • Group # (if Known):

 

Ultimately, as the policy holder, you are responsible for understanding your coverage and limitations. As the person who pays them, insurance companies will often give you more thorough information.

 

Accepted Insurances

Forest Family Dentistry is a Preferred Provider for a large number of major insurance companies, as well as participating in many small multi-company networks. We can accept most PPO plans, but we do encourage you to call your insurance provider to ensure we are an in-network provider with your specific plan. Some of the companies we’re in-network with include:

 

 

 

 

 

 

 

 


 

We are not in network with HMO, DMO, or DHL plans. However, if you would still like to be a patient of ours, we would love to take care of your dental needs. You would be seen as a fee for service patient, as we cannot file claims to any HMO, DMO or DHL plans, and you will not be receiving any reimbursement from them either.

  • Aetna         

  • BCBS (Texas, Illinois, Montana, New Mexico, Oklahoma)

  • Cigna 

  • Delta Dental

  • GEHA Connection

  • Guardia

  • HAAM

  • Humana Specialty Benefits

  • Metlife

  • Principal

  • Sun Life Financial

  • United Concordia (*Tricare only)

  • United Healthcare

  • Always Care/Starmount

 2700 W Anderson Ln #418

 Austin, TX 78757