MICHIANA ORAL AND MAXILLOFACIAL SURGERY, INC. JAY ASDELL, DDS 707 North Michigan St Suite 300 South Bend, IN 46601 (574) 289-0080 (800) 736-6053 HOME GET TO KNOW US Meet Dr. Asdell Meet The Surgical Staff SERVICES WE PROVIDE Implants Corrective Jaw Surgery Wisdom Teeth Oral Pathology Frenectomy Anesthesia SAFETY FOR OUR PATIENTS Sterilization & Certification OFFICE INFORMATION Hours/Scheduling Directions Financial Arrangements Registration Form Privacy Policy POST-OPERATIVE RECOVERY Following Oral Surgery Following Dental Implants Following Orthognathic Surgery FREQUENTLY ASKED QUESTIONS General Office Info Financial Surgical FEEDBACK FORM Request Info & E-mail Us

Financial/Insurance Information

What is covered by my insurance benefit plan? Your plan sponsor (typically your employer) must provide you with a document describing your coverage and listing any limitations and exclusions. The plan document should also specify who is eligible for coverage under the plan and when that coverage is in effect. My plan says it covers "100% of usual and customary charges." Does that mean I don't have to pay anything? The key is to remember that your insurance plan is a means of payment assistance, which enables you to obtain the care you need and deserve. The third-party payer (usually an insurance company) can set limits on the amount of the benefit for any procedure. Although these limits are called "customary," they may not reflect the fees charged. My spouse and I have separate insurance plans. How can we coordinate our coverage? Which plan covers our children? Although you and your spouse are each covered under your own policies, you may be able to satisfy the deductible on one plan through the coverage offered under the second policy. Your children are covered under your "primary plan." Which plan is primary depends on the regulations in your state. The ADA recognizes the common "birthday rule" for coordinating benefits, which says that the spouse with the birthday occurring earlier in the calendar year is the primary plan holder. Other plans, however, consider the father's plan primary. Check the coordination of benefits language in each policy, or consult your plan sponsor, to determine the benefit coordination options available to you. Do you have to submit a treatment plan to the insurance company before going ahead with treatment? Although you and your doctor ultimately will decide the best treatment for your needs, some plans call for a process known as pre-determination. This means that the insurance company will review your doctor's estimate of charges and procedures, and determine what benefits you are entitled to for the proposed dental work. There may also be a provision in your plan that will deny your insurance benefit, or reduce the level of coverage, if you do not submit the treatment plan for prior approval. Can you bill my ex-husband for services in your office? I have a court document stating that he's responsible for my child's medical/dental expenses. We understand your dilemma, although the party accompanying the child is also the financial responsible party. If your ex-husband is willing to sign a financial responsibility statement, our business office will gladly discuss the financial obligation with him instead. What are your fees? Fees are based on the complexity of the procedure and are relative to the level of care extended. Therefore, we recommend you contact our business office or see our doctors for a consultation for your treatment estimate. All consultations begin at $60.00 What is pre-certification? Most insurance plans feature a certification program that is designed to help you make a more informed decision about the medical necessity for a planned hospital stay or surgical procedure. Being confined in a hospital or going through the ordeal of surgery is rarely pleasant, and even less so if it is unnecessary. Studies have shown that a surprisingly large percentage of hospital admissions are medically inappropriate. In fact, many of the surgical procedures and treatments frequently performed during a hospital stay could be performed safely on an outpatient basis. Hospital admission/surgery pre-certification: IMPORTANT...You must call your insurance carrier prior to being admitted for a non-emergency hospital stay or scheduled surgery outside our office. If you do not follow this procedure, you may have to accept increased financial responsibility for your care. How pre-certification works: The information that you provide is put into the computer at the insurance company and begins the pre-certification process. If the insurance company needs further information, our office is contacted by a registered nurse at your insurance company, and additional information is provided. If the insurance company and our physicians are in agreement about the medical necessity of the length of your hospital stay, under the terms of your insurance contract, your insurance carrier will certify the treatment. If your insurance carrier will not certify your treatment as medically necessary, there may be a reduction in coverage or no payment. Why review is necessary: Most insurance plans contain these provisions as one means of holding down excessive medical care costs. Your decision to accept or reject the recommendation of Dr. Asdell or your insurance carrier cannot be questioned. Further, in the event that a proposed hospitalization or length of hospital stay is not certified as medically necessary under the terms of your insurance plan, you will be advised before any costs are incurred. You will then be able to determine whether you wish to accept the possibility of increased financial responsibility for your care. *REMEMBER* PRE-CERTIFICATION IS REQUIRED BEFORE MOST HOSPITAL SURGERIES AND IS YOUR RESPONSIBILITY My question is not listed.