Insurance

If your insurance covers dental treatment, you will receive the benefit of reduced personal costs. Insurance policies vary, so we will review your insurance to determine the appropriate course of action. Once treatment has started, we will file your claims as a courtesy to you.

G. Joel Funari’s office is a preferred provider for most major insurance companies. The specific medical and dental plans are listed at the bottom of this page.

To help us with your insurance filing, please complete the insurance questions on our questionnaire.

Please remember that dental insurance is a benefit for you or your child. If, during the course of treatment, your benefits change, the financially responsible party is accountable for all charges.

 

To allow us to continue providing quality surgical care at affordable costs to our patients the practice adheres to the following billing, collection, and cancellation policies: 

 

 Financial Policies

 

     If you have no insurance, or carry an insurance plan we do not participate with, charges for services are due and payable at the time service is rendered unless other arrangements have been made prior to treatment.  The office will not bill for services and does not extend credit for treatment provided. Our participation in major medical and dental insurance plans make it illegal to offer discounts on established fee schedules. For your convenience, we accept Cash, Check, MasterCard, and Visa.

      We will file insurances claims for those insurance plans in which we participate. For those insurance plans that we do not participate in, we will be happy to provide an itemized receipt to file with your insurance company. Simply attach the receipt to a claim form.    

      We are not a Medicare or Medicaid provider.  We cannot, nor can you, submit Medicare claims. Medicare supplemental insurances require that a claim be filed and processed by Medicare before bills may be submitted to them. As such they may not cover any charges submitted to them.

    

      Please remember you are fully responsible to the doctor for all charges on your account regardless of your insurance schedule, coverage, or payment.

 

Insurance Information

     Dr. Funari participates with most major medical and dental insurance companies.  The large number of insurance companies, each with multiple plans having different eligibility criteria, make it impossible for us to calculate the exact amount your insurance will pay for certain procedures. Due to recently enacted HIPPA laws it is sometimes impossible for us to get complete information from insurance companies. It is your responsibility as a patient or sponsor to check with your insurance company to see if there is coverage under your policy for the particular service to be provided.

      We encourage you to contact your insurance company directly to determine limits of your coverage.  We will be happy to provide the appropriate diagnosis and procedure codes to make your inquiry more accurate.  Be ware that this "predetermination" is not a guarantee of the payment once the claim is filed. You are responsible for payment of any procedure that your insurance carrier deems no a covered benefit, medically necessary or experimental/investigational.  

      It is important that we have current copies of both your medical and dental insurance cards to assist you with insurance reimbursement.  Some of your procedures may be covered under your medical insurance and some under dental. Additionally, some procedures may only be covered if provided in conjunction with other procedures.  It is also important to note that HMO plans require referrals prior to treatment. HMO patients are responsible for obtaining a referral from oyur primary care physician prior to any services being rendered.  If you do no have a referral for your office visit or treatment, you are responsible for payment in ful at the time of service. We will be glad to assist you in obtaining this referral from your physician.

     After the consultation and prior to your surgery, we will be happy to provide you with the necessary information to allow you to call your insurance company and get "verbal" confirmation of eligibility and benefit coverage.   Be aware that, despite every effort to obtain accurate information from your insurance company, what they tell you is not a binding agreement for payment. You will not know what they will reimburse until the claim is filed. Also, due to unanticipated findings at the time of surgery, the procedures actually performed by may differ from those discussed at the consultation which may affect what the insurance companies will reimburse.

 

Many factors affect the amount your insurance will pay. Some of these are:

  • Pre-existing conditions
  • Deductibles
  • Policy limitations for certain procedures
  • Yearly maximums
  • Benefits already used
  • Student status requirements
  • Plan year renewal dates
  • Usual and customary fees
  • Coordination of benefits or non-duplication clauses
  • Allowable amounts
  • Fee schedules
  • Missing tooth clauses
  • Age limitations
  • Investigational / experimental procedures

     Many times the insurance plan requires payment of "co-pays" and "deductibles". For Medical participating programs, you are responsible for the co-pay.  For Dental participating programs you are responsible for your cost share, commonly 20% of the charges.  You will be responsible for any balance remaining after payment is received from your insurance company.   There is  a legal requirement for a subscriber to pay these fees directly to the provider for treatment.  A deposit will be requested at the time of treatment as a credit agains these unpaid items.  Even if you have double coverage (this is possible if a spouse has insurance coverage), there may still be a portion of the charges that will be your responsibility.  The amount we ask you to pay on the date of service is only an estimated amount.  

     If you have questions regarding your insurance, please contact our office. Our insurance staff is very familiar with insurance and will be happy to help you.

    

We work with all indemnity insurance plans. However, we are preferred providers for those companies listed below.

 

                        Insurance Plan Participation

                 Dental

Aetna

Assurant (PPO)

Cigna

                   Cigna – Great West

 

                   DeCare Dental (Teamsters)
 

Delta

 

Dentemax

 

Guardian

 

Humana

 

Met Life

 

United Concordia

 

 

 

Medical

 

Aetna (PPO & HMO)

 

Blue Cross/Blue Shield

 

Blue Cross/Blue Shield - Empire

 

Cigna

 

Cigna – Great West

 

Highmark

 

Horizon (NJ)

 

Independent Blue Cross

 

Keystone Health Plan East

 

 Keystone 65

 

Personal Choice

 

Tricare / Health-Net (Government Plan)

 

United Health Care   

FAILURE POLICY

Broken appointments are costly to the practice and deny others access to care.  Appointment failure or those canceled with less than 24 hours’ notice are subject to a $100.00 cancellation fee.  This fee is not covered by insurance policies and will be billed directly to the individual responsible for the account. 

COLLECTION POLICY

In the event it becomes necessary for your account to be referred to a collection agency or an attorney, the patient or legally responsible party will be assessed the actual collection costs, attorney’s fees, and court fees which are incurred and a practice administrative fee.  You will be held responsible for the entire balance on the account and any insurance adjustments afforded you due to insurance participation will become null and void. Additionally, we have the right to assess account charges on overdue balances at the rate of 1.5% per month (18% per year) after the initial 60 day grace period.

Checks returned by your bank are subject to a $50.00 processing fee, bank charges and will subject the account to accrual of late payment fees.



       

  
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