Dental Insurance Information
Using Dental Insurance at Dental Implant & Reconstructive Center
Dental Implant & Reconstructive Center in Duluth MN
Dental Implant & Reconstructive Center is a fee-for-service, out-of-network prosthodontic practice. Dr. Roxanna J. Esguerra is not contracted with dental insurance companies. Treatment recommendations are based on your individual clinical needs and treatment goals rather than the limitations of an insurance plan.
If you have dental insurance, you may still be eligible for reimbursement according to the terms of your plan. The following answers explain how dental insurance works in our office.
DOES DR. ESGUERRA ACCEPT DENTAL INSURANCE?
Dr. Esguerra is not contracted with any dental insurance company and is considered an out-of-network provider.
You may still be able to use your dental insurance benefits. Coverage and reimbursement depend on your individual plan.
WILL YOUR OFFICE SUBMIT CLAIMS TO MY INSURANCE COMPANY?
Our office provides you with a completed paper claim form that includes the appropriate procedure codes, treatment dates, fees, and Dr. Esguerra’s signature. You are responsible for submitting the claim to your insurance company.
Any reimbursement from your insurance company is paid directly to you.
HOW MUCH WILL MY DENTAL INSURANCE COVER?
Every dental insurance plan is different. For most prosthodontic and implant treatment, insurance covers only a small portion of the total treatment cost.
In our experience, insurance reimbursement averages approximately 5% of the total treatment fee. Your actual benefits may be higher or lower depending on your individual plan, annual maximum, deductible, exclusions, waiting periods, and other limitations.
WHAT IS AN ANNUAL MAXIMUM?
Your annual maximum is the most your dental insurance company will pay toward covered dental treatment during a benefit year.
Many plans have annual maximums between $1,000 and $2,500. Once your available annual benefit has been reached, additional treatment costs are your responsibility.
CAN YOUR OFFICE SUBMIT A PREAUTHORIZATION?
Yes. Upon request, we can submit a preauthorization to your dental insurance company.
A preauthorization may help you better understand how your insurance company intends to process a proposed treatment. It is not, however, a guarantee of payment.
DOES A PREAUTHORIZATION TELL ME EXACTLY WHAT MY INSURANCE WILL PAY?
Not necessarily. A preauthorization is an estimate and may not reflect your remaining benefits, annual maximum, deductible, waiting periods, exclusions, or other plan limitations.
Actual reimbursement may be different from the amount shown on a preauthorization.
HOW CAN I LEARN MORE ABOUT MY DENTAL INSURANCE BENEFITS?
We encourage you to contact your insurance company directly and request a detailed summary of your benefits.
Ask specifically about your:
- annual maximum
- remaining benefits
- deductible
- waiting periods
- out-of-network benefits
- implant and prosthodontic coverage
- exclusions or frequency limitations
WHAT IF MY INSURANCE COMPANY REQUESTS ADDITIONAL RECORDS?
Upon your written request, our office can provide copies of available radiographs and standard clinical chart documentation for insurance purposes.
Requests must be submitted in writing. We do not process documentation requests received by telephone or text message.
WHAT IF MY INSURANCE COMPANY REQUESTS A CUSTOM NARRATIVE, APPEAL, OR REPORT?
Insurance companies occasionally request custom narratives, appeal letters, treatment summaries, or other documentation beyond copies of existing radiographs and standard clinical records.
Preparing custom documentation requires additional doctor and staff time and is not included in your treatment fees. A $325 fee applies to custom narratives or documentation requests beyond copies of existing radiographs and standard clinical chart records.
WHO IS RESPONSIBLE FOR PAYMENT?
Payment to Dental Implant & Reconstructive Center is due according to the terms of your treatment agreement. Your dental insurance benefits do not change the payment arrangements made with our office.
Any reimbursement provided by your insurance company is paid directly to you.
Dental insurance is a contract between you and your insurance company. While we are happy to help you obtain benefits available under your plan, we cannot guarantee coverage or reimbursement.
Questions about insurance should never keep you from understanding your treatment options. Our team is happy to explain how our office works and what information you can request from your insurance company before making decisions about your care.