Do I need a referral to schedule an appointment for a new patient examination?
You may make an appointment any time by simply contacting our office. Many of our patients are referred to us for diagnosis and treatment of TMD and sleep-disordered breathing by their general dentist, family physician or other medical specialist (e.g., ENT, neurologist, otorhinolaryngolgist, etc.). However, a referral is not required. *Note: If you are insured by an HMO, you may find it beneficial to obtain a referral from your primary care physician. This is because HMOs require a referral in order for patients to submit claims for the cost of any covered benefits.
When are treatment options discussed?
We are committed to providing quality care that gets results. Following a thorough examination by the doctors, treatment options will be presented. Treatment plans are developed based on a specific diagnosis and desired outcomes. Until you have been thoroughly evaluated by our office, we cannot determine your treatment plan or the cost of your treatment because our fees are based on the severity and complexity of each case.
Following discussion of your treatment options and your treatment plan, a financial/insurance consultation will be conducted. During your financial/insurance consultation, we will outline treatment fees for the first three months of your treatment and review payment options with you. This is why we recommend that you bring anyone involved in making healthcare and financial decisions with you to your first appointment.
How does the office handle insurance coverage?
TMD: TMD is a medical condition; however, it is unusual for treatment to be covered fully by medical and/or dental insurance plans. This explains, in part, why we are a “fee for service” practice and why our patients (or their parents/legal guardians) are solely responsible for payment of all fees. That said, we will provide you with all of the documentation you need to file with your insurance company, so that you have the best possible chance of coverage. We will also answer questions and provide information in response to questions from your insurance company to assist you in obtaining any/all insurance benefits to which you may be entitled.
SLEEP: Dental sleep medicine treatment of snoring and obstructive sleep apnea may be covered by your insurance plan, especially if you have completed a diagnostic polysomnographic (sleep) study, which must be prescribed by a physician. If you are a CPAP user, we can provide you with a CPAP Intolerance Affidavit.
Why can’t you accept direct insurance assignment?
As dental professionals, our responsibility is to deliver consistently excellent care that gets results. We do not develop treatment plans based on what your insurance company will reimburse or deems “usual and customary.” Instead, our relationship is with you: our patient. As a patient, you have a relationship with your insurance company. We will provide you with an insurance claim form at the end of each visit to our office, so that you can seek maximum benefits directly from your dental and/or medical insurance providers. However, we cannot accept insurance assignment because:
Benefits information is inconsistent
- Insurance companies frequently exclude treatment of temporomandibular disorders and,
- There are extreme delays in receipt of monies
Who can I contact if I have an insurance concern or complaint?
In addition to communicating directly with your employer (if you are covered by an employer-sponsored health plan) and your insurance company, California residents may also wish to express their concerns to the California State Insurance Commissioner. Written complaints should be addressed as follows: State Insurance Commissioner CALIFORNIA