To estimate coverage for an out-of-network insurance carrier, you will based the patient’s percentage of coverage off of our office fee since we don’t know what fee the insurance company will use.

Example: If the patient has 70% filling coverage, the patient will owe 30% of our office fee. 

Estimates, treatment plans, commlogs, and patient conversations should also reference that we will balance bill once the claim processes. The patient might end up with a balance if the insurance company determines our office fee is too high.