Insurance Options

At St. Augustine Oral & Facial Surgical Center, we strive to make high-quality oral and maxillofacial surgical care accessible and affordable for all our patients. Understanding your insurance coverage and benefits is an important part of your care experience with us.

In-Network Providers

We are proud to be in-network with several major dental insurance providers to help maximize your benefits and minimize your out-of-pocket expenses. We currently participate with:

• Delta Dental
• Humana
• Cigna Dental

PPO Plans

In addition to our in-network partnerships, we work with most PPO (Preferred Provider Organization) dental plans. As a courtesy to our patients, we will file claims for all PPO dental plans, even if we are not formally in-network with your specific carrier.

Understanding Dental Insurance for Oral Surgery

Dental insurance can be complex, especially when it comes to specialized procedures like oral surgery. Here are some important things to know:

In-Network vs. Out-of-Network Coverage

In-Network Coverage:

• We have negotiated fee agreements with these insurance companies
• Your out-of-pocket costs are typically lower
• Benefits are maximized according to your plan

Out-of-Network Coverage:

• We will still file your claim as a courtesy
• Your insurance may reimburse at a lower rate
• You may have higher deductibles or co-insurance

Common Insurance Terms Explained

• Deductible: The amount you must pay out-of-pocket before your insurance begins to pay
• Co-payment: A fixed amount you pay for a covered healthcare service
• Co-insurance: The percentage of costs you pay after you’ve met your deductible
• Annual Maximum: The total amount your plan will pay for dental care within a specific period (usually a calendar year)
• Pre-authorization: Prior approval from your insurance company that may be required for certain procedures

Medical Insurance for Oral Surgery

Some oral surgery procedures may be covered by your medical insurance rather than dental insurance, particularly when they are:

• Medically necessary for your overall health
• Related to trauma or accidents
• Associated with certain pathological conditions
• Addressing sleep apnea or TMJ disorders

Our experienced staff will help determine whether your procedure might qualify for medical insurance coverage and assist with the appropriate claim filing.

Insurance Verification Process

When you schedule your appointment, we will:

1. Collect your insurance information
2. Verify your coverage and benefits
3. Provide you with an estimate of your out-of-pocket costs
4. Discuss any pre-authorizations that may be required

Patient Responsibility

While we are happy to assist with insurance matters, please remember:

• The contract is between you and your insurance company
• You are ultimately responsible for all fees not covered by insurance
• We recommend that you familiarize yourself with your insurance plan’s coverage for oral surgery procedures
• Please notify our office of any changes to your insurance coverage

Insurance FAQs

Q: How do I know if my procedure is covered by my insurance?
A: Our team will verify your benefits prior to your procedure and provide you with an estimate of coverage. However, insurance companies make the final determination when processing the claim.

Q: What if my insurance doesn’t cover my procedure?
A: Some procedures may not be covered by insurance or may be only partially covered. We offer several payment options, including CareCredit financing, to help make your treatment affordable.

Q: Do you file my insurance claims for me?
A: Yes! We file all insurance claims as a courtesy to our patients and track them throughout the process.

Q: How long does it take for insurance to pay?
A: Most insurance companies respond to claims within 4-6 weeks. If you haven’t received an explanation of benefits from your insurance company within this timeframe, we encourage you to contact them directly.

Payment Options for Non-Covered Services

For procedures not covered by insurance, or to cover your portion of costs, we accept:

• Credit cards (Visa, MasterCard, Discover)
• Cash
• Personal checks
• CareCredit healthcare financing

Need Help Understanding Your Coverage?

Our knowledgeable front office team is here to help! Whether you’re unsure about your insurance coverage or exploring financing options, we’re happy to answer your questions and guide you every step of the way.

Call us today at 904-460-0505 to learn more about how we can work with your budget and insurance plan.