SHARON MIYAMOTO, DDS

Insurance

Our insurance coordinators deal with many different insurance companies. Some companies offer numerous dental and medical plans. These companies can change benefits, co-payments, and deductibles throughout the year.

We do our best to provide you with accurate coverage estimates based on information available to us with an electronic service. Yet, it can be very challenging to estimate a patient’s insurance co-payment accurately. Most insurance companies will not give out fees to providers until after treatment is completed.

Dealing with the complexities of dental insurance companies can be difficult and time-consuming. We ask that you keep us informed of any changes to your insurance, because it is essential that all information is current for billing purposes.

As a courtesy to our patients, we will submit the necessary claim forms, receipts, documentation, narratives and other information to your insurance company on your behalf.

 

Co-Payment

The range of benefits depends solely on what your employer wishes to purchase. Some plans cover as little as 30% of dental services, and some as much as 100%, though most fall into the 40% to 80% range.

Upon receipt of an insurance payment, any balance from your co-payment due will be billed to you. If you have deposited an excessive co-payment, it will be refunded to you.

Fee Schedule Insurance Plans: Some plans base the amount of benefits on a schedule of fees arbitrarily developed by insurance companies. For this reason, you may receive a lower percentage than the reimbursement level indicated in your dental plan. For example, if you plan states that it will pay 80% of the cost of a specific treatment, it means 80% of the fee arbitrarily determined by the company and not the actual fee charged by our office.

 

FAQ’s

1. Will my insurance cover my periodontal treatment?

Insurance plans tend to provide assistance for periodontal treatment. You usually have an annual maximum of $1000 to $2500. Our practice understands how important your dental health is, and we want you to get the most out of any dental treatment you receive. We will be happy to send in a predetermination claim to your insurance to find out what amount you will be reimbursed in advance of treatment. Just inquire with your treatment coordinator. We also have different payment options available.

 

2. Do you accept my insurance plan?

Yes, Dr Miyamoto accepts most PPO insurance plans. Our office is also a member of the Delta Dental PPO and Delta Dental Premier plans.

 

3. Do you take HMO, Medicare, or Medical?

No, we are not in network.

 

4. Do you bill medical?

No, we do not have medical codes, but we will provide you with the forms necessary for you to submit a claim to your carrier.

 

5. Why do I have a balance even though I have insurance and have paid my co-pay?

We estimate your co-pay and if we are not able to get the exact amount we underestimate instead of overcharging our patients.
Upon receipt of an insurance payment, any balance due will be billed to you and is the patient’s responsibility. If you have deposited a co-payment which gives you a credit after the insurance payment is received, it will be refunded to you.