For Patients with Insurance | Clarksville TN
About Your Insurance
- The most common misconception concerning insurance is that your policy will cover the total cost of surgical fees charged. Insurance is designed to reduce your out of pocket cost, but usually will not eliminate it entirely. Your portion is due at the time of service.
- Your surgical treatment is not dictated on what your insurance will cover. Together, your doctor and you create your treatment plan based on what your current medical and dental needs are. We cannot limit your care to just what is covered by your insurance plan. Every plan is different and each insurance company determines what is covered. Just because a particular service is not covered does NOT mean you do not need it.
- Insurance will only be filed for plans that we are provided with at the time of service. We will not “back file/retro-file” any claims. You must provide all insurance information at the time of service. You are responsible for filing any claims with insurance plans we were not made aware of.
- If your insurance policy requires a referral, that must be obtained prior to the appointment. We will not obtain “retro” authorizations for services not authorized in advance by the insurance company. It is the patient’s responsibility to know if their insurance plan requires a referral from their primary care doctor.
- Due to increases in postage and mail supplies, Cumberland Surgical Arts and Associates, PLLC will only send out ONE (1) billing statement per date of service. It is your responsibility to keep your account current and to update us with address changes as they occur. All account balances must be paid within THIRTY (30) days from the date on the statement.
- Insurance will NOT be filed for cosmetic surgery procedures. If Dr. Lee determines that your procedure may be considered medically necessary by your insurance company, then we will assist you in filing the appropriate insurance paperwork. Final determination of medical necessity for insurance purposes is made by your insurance company.
- Insurance coverage will be verified at the time of service. You must provide this office with an insurance card or proof of coverage. If coverage is unable to be verified, you are responsible for all charges incurred.
- Upon verification of insurance benefits, we will attempt to estimate your portion of fees due. You are responsible for any co-insurance amounts prior to surgery.
- Responsible parties with insurance coverage can either:
- File insurance yourself and pay us in full directly the day services are rendered. We will assist you with your paperwork.
- Have us file your insurance. We will only file with 2 insurance plans. Filing of any additional plans will be your responsibility. You must have on the day of your appointment:
- Insurance card with Subscriber’s information
- Photo ID (We do not file ANY insurance without a photo ID – driver’s license, Military ID)
- The co-payment and deductible (as applicable) the day services are rendered. Co-payment can vary with insurance plans.
We file most insurance plans as a courtesy to our patients. These include, but are not limited to:
- Delta Dental
- Blue Cross Blue Shield Medical and Dental plans
- Tricare Medical
- MetLife Dental (including for military dependents)
- United Concordia and United Concordia Active Duty Dental Plan
- Select Cigna Dental plans
- DenteMax network participating plans
- TennCare Medical (Amerigroup and Americhoice)
- DentaQuest Dental for TennCare participants under age 21
- Please call the office at Rudolphtown Office Phone Number 931-552-3292 to inquire we if we are a participating provider for your plan.
- We have learned that many plans (that we are not a participating provider with) provide coverage using Out-of-Network benefits just as well as with an in-network provider PLUS allow more freedom between you and your surgeon in determining the best treatment course for YOUR condition.
About Estimates for Surgery
- We are not privileged to all insurance plans limitations and exclusions. You, as the beneficiary of the insurance policy, are responsible for knowing all policy limitations and exclusions. The contract for benefits is between you and your insurance company; our only relationship is with you, the patient.
- We will prepare an estimate of insurance payment and your responsibility. This is prepared using information provided by your insurance plan’s representative. We only use the information they provide us with, so if the information is not current, inaccurate, or lacking in detail, that will affect the treatment plan estimate we provide you with. Neither we, nor the insurance company, can guarantee the estimated payment amounts. Please understand that the estimate generated is provided as a courtesy.
- We will assist you in understanding your benefits, but are not responsible for your benefits or what is ultimately paid by your insurance plan. Any discrepancies should be addressed with your insurance company as they make the final determination of benefits provided, not us.
- You are responsible for verifying that all waiting periods have been satisfied prior to surgery.
- We cannot be held to the estimate of insurance benefits, as it is only an estimate based on information provided on the day it is generated. Annual maximums, deductibles, and percentages of coverage may be different on the day of surgery based on care received by other practitioners and the medical necessity of the procedure as determined by your insurance company.
- Our doctors do not determine medical necessity for your insurance company, but will assist in providing justification for surgery to your insurance company to assist in determination of benefits. You, as the patient, are ultimately responsible for the full amount of the surgical cost.
* Remember insurance is filed solely as a courtesy to our patients. Please help us to keep this service available to all patients. *