Dr. Matthew Sandberg and his dental team want to give our patients flexible payment options whatever their treatment, whether they have insurance or not.
Firefly Family Dentistry accepts many dental insurances. Our practice may be listed under Sandberg Modern Dental, LLC on your insurance carrier’s website.
Our staff works with the insurance companies and new computer systems to accurately predict the amount a patient will owe out of pocket. The patient out of pocket payment is required at the time of service. Any over or underpayment will be promptly billed or reimbursed.
The following are the most common dental insurance PPO plans accepted by Firefly Family Dentistry:
- Delta Dental
- United Healthcare
Other plans may be accepted, however we recommend contacting your insurance provider to inquire prior to your visit.
Our office is out of network with all discount insurance plans, state insurance title 19, and HMO plans. However, we will submit claims for discount insurance plans and out of network insurance carriers on your behalf. Firefly Family Dentistry requires full payment of our fees by the patient at time of service. Depending on your insurance or discount plan, a reimbursement check will be sent directly to you or to our office. If the check is returned to Firefly Family Dentistry, we will contact you to forward the appropriate reimbursement.
How Dental Insurance Works
Dental insurance varies greatly from medical insurance. Dental insurance helps patients offset some of the cost of dental care, whereas medical insurance helps protect against the potential very high cost of medical expenses.
Dental insurance coverage varies greatly from plan to plan, typically dependent on the level of coverage purchased by the patient or the patient’s employer. The insurance plan is negotiated by your employer and typically has little to do with patients actual dental needs nor is maintaining optimum dental health the goal of the plan. Dental insurance simply helps offset some of these costs. Plans that cost less typically require greater contribution by the patient at the time of service.
Understanding common dental insurance terms helps to understand your policy:
- Insurance Networks: Insurance companies create networks in which doctors can participate. Some insurance plans will cover patients regardless if the doctor is in or out of network with the insurance company. Others will only cover services that are treated by an in network doctor. It is important to call your insurance company to verify if your insurance company and your plan are covered by our office. Insurance companies are constantly being purchased and merged, or change the terms of their network policies. Our office is typically not notified of these changes.
- Fee Schedule: If our office is in network with your insurance company, we have agreed to a discounted amount we will charge our patients for various procedures. This fee schedule is a discount our office provides to help you offset dental costs.
- Maximum: Most dental plans have a specific maximum amount the plan will pay in a given benefit period. After this amount is paid by the insurance company, the patient must cover all remaining and future costs incurred during the benefit period. The fees will still be discounted to the fee schedule set by the insurance even if the maximum is met.
- Deductible: Your deductible is the amount you are required to pay our dental office prior to insurance considering any payment. The amount of your deductible, and to what services the deductible will apply, varies by plan. Typically, deductibles must be met once per year. For family plans, each individual on the plan is required to meet a deductible up to the amount stipulated by the insurance plan.
- Coinsurance: Most plans will pay a percentage of predetermined dental services and require the patient to cover the remaining costs. The remaining cost is called the coinsurance. This term can be confusing, as coinsurance simply is the remaining amount the insurance company will not pay, not necessarily a cost to be paid by a different insurance plan. This remaining amount must be covered by the patient or a secondary, independent, insurance plan.
- Waiting Period: Some plans will not pay for select or all services until the patient has held the plan for a set amount of time. Typically, waiting periods apply to services more extensive than basic preventitive treatment.
- Limitations or Exclusions: Dental insurance plans have many limitations or exclusions, an outline of the procedures the insurance company will not cover, will only cover a set number of times per year, or will only cover outside of set time period. This does not mean the procedure is not necessary. However the insurance company has not included this procedure in its coverage plan due to the contracted agreement dictated by the price you or your employer paid for the plan.
- Downgrades: Many dental conditions have multiple treatment options. Most dental insurance plans may only pay benefits based on the Least Expensive Alternative Treatment (LEAT). Insurance companies will not deny more preferable services, however they will only compute their benefit payments based on the cost of the LEAT service. The patient is obligated to pay the different between the cost of the service received and the LEAT service, plus any remaining coinsurance and deductible.
- Dual Coverage: Some patients have two insurance plans to help offset dental costs. Coordination of benefits between plans can be very convoluted. Dual coverage does not double your coverage, it helps offset more dental costs. Your primary plan will pay as it typical would if you only had one insurance plan, and the secondary plan will help offset the remaining costs after primary insurance pays.
All these factors (and in some cases, additional rules) are considered when our office and insurance companies compute the cost of services. Our staff has been trained to help assist you with understanding your insurance benefits, however it is your responsibility to understand your plan benefits. Our office works with numerous insurance companies, each which can have hundreds of different plan options. We will do our best to assist you in any way possible, but please remember it is impossible for our staff to study every detail of every plan. It is advised you understand your benefits prior to any procedure. All expenses incurred in our office are your responsibility.
The treatments recommended by Dr. Sandberg are not created based on your insurance plan, rather they are created in the best interest of your individual dental health and successful treatment of your dental needs.
Dental treatment is an excellent investment in an individual’s overall healthcare. However, Firefly Family Dentistry realizes that every person’s financial situation differs. We provide a variety of payment options to help you receive the dental care you desire with respect to your budget. We are always available to answer your questions or assist you in any way we can.
Please note, full payment is required at time of service. Patients with insurance plans will be required to pay his or her portion of the dental service at the time of service. For your convenience, individuals without dental insurance will receive a 5% discount off the total treatment price. We except cash, most credit cards, and checks. A $50 fee will be added to the account for any returned check.
Please contact our office as soon as possible to reschedule or cancel your appointment. We require a 24 hour notice for cancelling or rescheduling appointments. Missed appointments without a 24 hour notice will be charged from $25 up to a $200 fee, depending on appointment type and length.
Call 414-258-8190 if you have any questions about the payment choices for your dental appointment in Wauwatosa , Wisconsin.