FINANCIAL INFORMATION
GENERAL FINANCIAL INFORMATION
Capital Children’s is dedicated to delivering you the best possible care. If you have medical insurance, we are happy to help you receive your maximum allowable benefits. In order to achieve this successfully, we need your assistance and your understanding of our payment policy.
IT IS IMPORTANT TO UNDERSTAND THAT THERE ARE SEPARATE CHARGES FOR THE FACILITY, THE PHYSICIAN/DENTIST/SURGEON, AND ANESTHESIA.
As part of the Capital Children’s patient rights and responsibility guidelines, we believe you have a right to know how we file for reimbursement, and what your financial responsibility is to us prior to your surgery.
UNDERSTANDING YOUR BILL
Similar to going to the hospital, you will be billed for three items:
Dental Surgery Fee (charged by your dentist, to cover the dentist’s time and efforts)
Facility Fee (Charged by the facility, to cover nurses, supplies, etc)
Anesthesia Fee (charged by the anesthesiologist to cover the anesthesiologist’s time and efforts)
Your dental surgeon will charge you any fees and copays directly. This covers things like crowns, fillings, extractions, cleanings, etc. They will usually submit your claim to insurance and the estimated copay will be the portion that is not covered by your insurance, though sometimes actual copays differ from estimated copays.
The Facility Fee will usually be covered at least in part by your medical insurance. This fee covers the nurses, scheduling staff, supplies and rent for the facility. Our billing company will send our charges to your insurance company, who will adjudicate the claim and advise our billing company how much you owe. They will send an “Explanation of Benefits”–this is not a bill, just a description of what your insurance company covers.
You will receive an estimate for copay owed on your Facility Fee that must be paid prior to your appointment. If you do not, please contact the billing department via email at finance@dentalsurgerydc.com to inquire regarding the status of your bill. On rare occasions the patient needs to contact the insurance company to facilitate payment.
The anesthesia fees or copay owed will also be collected before the treatment.
We are always striving to ensure that you maximize the usage of insurance benefits available to you–please contact a billing specialist for more information.
INSURANCE PARTICIPATION
We participate with many insurance carriers including:
State Insurances:
- Maryland Medicaid for REM patients and (children ages 0-20)
- Amerigroup (DC Medicaid MCO)
- AmeriHealth (DC Medicaid MCO)
- Health Services for Children with Special Needs (DC Medicaid MCO)
- Trusted Health Plan (DC Medicaid MCO)
- Virginia Medicaid (children ages 0-20)
- United Healthcare (Maryland adult Medicaid, ages 21+)
Private Insurances:
- CareFirst
- Kaiser Permanente
- United Healthcare
- Aetna
- Cigna
- Humana
Participation means that we follow the insurance carrier’s guidelines for the amount determined payable on a given claim, minus any deductibles, co-pays, or co-insurance due from the patient. If, during the verification process, it is discovered that an out-of-pocket expense is due, it must be paid in advance. To assist you in making a payment, the BC accepts Visa, MasterCard, American Express, and Discover.
For patients who would like to finance their treatment, we work with the following financing companies:
- Care Credit https://www.carecredit.com
- Lending Club https://www.lendingclub.com
Contact a billing specialist for more information about these programs
PRE-APPROVAL PROCESS
Your insurance coverage will be verified prior to the date of your procedure. A patient account representative will contact your insurance carrier to:
- Verify approval for the medical necessity of the treatment.
- Confirm that a valid referral is on file, if required.
- Determine co-pay/co-insurance or deductible liability if possible.
- Verify your eligibility and benefits.
DAY OF SURGERY
On the day of surgery, it is vital that you bring your most updated insurance card(s) along with photo identification. When needed, we do our best to obtain all referrals prior to the appointment. If we are unable to obtain a referral, it is your responsibility to bring it to the appointment.
If you are insured by a managed care payer, it is a requirement that you have a referral. Your primary dentist’s office should provide you with a referral indicating surgery to be performed at Capital Children’s. If you do not bring that referral, it may potentially postpone or cancel your procedure.
PATIENTS WITHOUT INSURANCE
If you are not covered by an insurance carrier, we ask that you speak with a Capital Children’s representative prior to treatment to discuss your financial situation. It is the policy of the center to request payment in full prior to the date of service.
PAST DUE ACCOUNTS
Please remember that when you receive our statements, you have already received quality healthcare and your insurance has been initiated by us. We would ask that you pay promptly upon receiving your statement.
If you are not able to pay your account in full, please contact one of our patient account representatives to avoid the collection process. If it becomes necessary, past-due accounts will be turned over to a collection agency.
IF YOU HAVE QUESTIONS
Capital Children’s is committed to providing the highest quality of care to patients who require surgery. The center will take all necessary steps to insure appropriate reimbursement for all procedures performed at our facility.
If, at any time, you have specific questions regarding our reimbursement policy, do not hesitate to contact one of our patient account representatives.
