The following is a list of insurance companies for which Dr. Hornaday is a participating provider.
Dental Insurance Medical Insurance
♦Delta Dental Premier ♦Medicaid
♦Medicaid ♦Medicare
♦Encore
Please note that even though you may have one of the above plans your procedure may not be a covered service by your insurance. Please call us if you are unsure so that we can schedule a consultation for an examination and obtain your insurance information in order to contact your insurance company for you. Due to the complexities of dealing with insurance companies and HIPAA regulations, if you have not been seen in our office for a consultation or prior procedure, we will not be able to contact your insurance company. We feel that your time is valuable and want to be able to give you our undivided attention.
**SPECIAL NOTICE: As of Monday April 27, 2009, Dr. Hornaday will NO LONGER be a participating provider for the following:
- ♦Cardinal Health Alliance (which includes the following):
- Select Circle, Sagamore, Indiana Health Network, Lutheran Preferred,
- Unified Group Services, Humana, Meridian
Insurance Explained
One of the most persistent problems patients face is determining what is and isn't covered under their insurance policies. There is tremendous variability in the policies written not only by different insurance companies but also with policies written by the same insurance company for different employers.
Some procedures we perform may actually be covered only by your medical insurance, some only by your dental insurance, and some by both!
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TO BETTER ASSIST YOU IN UNDERSTANDING YOUR INSURANCE, PLEASE BRING YOUR MEDICAL AND DENTAL INFORMATION TO US ON YOUR FIRST VISIT. |
We are familiar with many insurance policies; but to protect your benefits we will try to get written pre-estimates of coverage prior to surgery if you so desire. Obtaining a written pre-estimate is advisable, but patients should know it could take up to 4 weeks or more for a reply. While some insurance companies still cover many procedures at 100% of our fee, the plan you or your employer selected may cover at a lower level of reimbursement. Many insurance plans now require payment of deductibles, co-pays, or have lower rates of reimbursement (often 50-90%). At the initial visit our office will always try to inform you before we perform any procedures of your ESTIMATED out-of-pocket expense. In this way you may best understand not only the surgical procedure which you require but also your financial obligation as well.
Our office policy is to request your estimated out-of-pocket expense (which we will assist you with) plus your remaining deductible to be paid on the date of surgery. This is for patients without written pre-estimates. The amount paid is an estimate, and after we bill the insurance, there may be an additional payment due. We will of course reimburse patients in the event of an overpayment.
Please remember that ultimately you, not your insurance company, are fully responsible for all fees charged by this office. It is essential that you provide us with all pertinent and current insurance information in order for us to properly bill your insurance company. It is your responsibility to inform our office if your insurance coverage has changed, termed, or if there is a waiting period before coverage begins.
"Usual and Customary Fees" Explained
Insurance companies term their allowable amounts "usual and customary" fees, also known as U & C. This is the amount of money that they allow for a given procedure and the amount from which they base their payment. The term "usual and customary" fee that your insurance company uses can be a little misleading since what they decide to cover for a procedure may not even be close to, or based on, what is charged by providers in your geographical region.
For example, if the fee for your service is $200, your insurance company pays at the 80% level and your insurance company's recognized ("usual and customary") fee is $150: they will pay 80% of the $150 which is $120 and the remaining $80 ($200 - $120) is the patient's responsibility. In this same example, if your insurance company pays at the 100% level: they recognize $150 as their "usual and customary" fee and will pay $150 since they pay "100%". The remaining balance of $50 ($200 - $150) will be the patients responsibility. Therefore, your insurance company may say they will pay at a certain percentage level, however this percentage is based on what they decide to allow, not the total fee charged. (Please note the above examples assume deductibles have been met or do not apply.)
Medicaid
Dr. Hornaday is a provider for Hoosier Healthwise (Medicaid). It is required that you present at the time of your service a current copy of your card. Medicaid provides payment for most services provided in an oral surgeon's office, however there are services for which Medicaid will NOT pay. If you are to have one of these services you will be asked to sign a waiver stating that you know you will be responsible for that payment on the day of service. If you have a spend down, you will also be responsible for any amount remaining on your spend down.
To obtain more information regarding Medicaid or to become enrolled, please click here.
Medicare
Dr. Hornaday is a provider for Medicare. Please note that Medicare does NOT pay for the removal of teeth and other procedures related to teeth. If you are covered under Medicare and are to have one of these procedures that is not covered, you will be asked to sign a waiver, also called the Advance Beneficiary Notice of Noncoverage (ABN), stating that you were informed that the procedure would not be covered and that the financial responsibility will be yours.