Although Dr. Zale participates as an “in-network” provider with several major dental companies, they do not allow a “pre-determination” for the initial exam.

Your first visit requires a payment of ($ 75. 00), due on the day of the initial exam and consultation.

If you have dental insurance coverage, a claim for the “Comprehensive Periodontal Evaluation” will be sent by mail directly from this office to your insurance company. Your insurance company will then process this claim according to your eligibility and dental benefit plan.

The fee for an Initial Consultation is to be paid on that same day as the initial visit.

After the exam Dr. Zale will submit a diagnosis, and a “pre-approval, i.e. pre-determination”, i.e. “pre-authorization” for the needed periodontal procedures. Weeks later you will receive the “pre-determination” with the costs for planned treatment and any discount for a participating periodontist. You will usually receive a written “pre-approval, i.e. pre-determination”, i.e. “pre-authorization”, directly from your insurance company in approximately 2 to 6 weeks, depending on the insurance company. ( Note: that there is usually a longer time for processing during the holiday and vacation seasons.

The “pre-approval, i.e. pre-determination”, i.e. “pre-authorization” which we send to your insurance company usually requires a full set of X-rays, the findings of the examination, and a proper periodontal treatment plan for all the gums. Your general dentist will submit for tooth procedures, but Dr. Zale submits claims for the periodontal procedures.

OVERALL FINANCIAL RESPONSIBILITY

Overall the financial obligation for your dental treatment rests with you, the patient. Dental benefit coverage of treatment is between you, your employer and the insurance company. If you believe that the dental benefits provided by your plan are inadequate you may wish to discuss the matter with your employer, union or association to investigate appropriate action.

It is important to inform Dr. Zale’s office manager of any change in the subscriber’s dental insurance company and or employee plan changes. If the subscriber changes companies, the new company starts the process from the beginning and usually requires an estimated 2 to 6 weeks for another written “pre-determination’ to indicate written approval for the procedures.

My office will try to answer your questions, but the insurance company is actually the source of my information on your individual dental plan. Their rules sometimes change with out you or me being notified, and will affect your benefits the subscriber.

For further information see the website of your insurance company.
The patient may delay treatment: “Deep Cleaning” i.e. Scaling and root planning, until a written “pre-determination” = “pre-D”, i.e. “pre-authorization” “pre-approval, i.e. “pre-authorization”, from their insurance carrier, is received. This takes approximately 2 to 6 weeks after a “pre-D” claim for a “deep cleaning” is sent to your insurance company. (Remember that a recent full set of radiographs is required for the written “pre-approval, i.e. pre-determination”, i.e. “pre-authorization” of definitive periodontal treatment). After the written “pre-determination” is received for a procedure, you the patient will know what your co-payment will be for that procedure, and this amount is due from the patient on the date of service.

A “pre-approval, i.e. pre-determination”, i.e. “pre-authorization” is valid for a specific time period, ranging between two months to one year. IF a “pre-approval, i.e. pre-determination”, i.e. “pre-authorization” expires, and an updated report is required by the insurance company, and IF an exam (D0180) is NOT covered by the Insurance plan – then the patient will be responsible for payment of this exam. That fee is due on the day of service.

Please remember that our professional services are rendered to you, not the insurance company, therefore you are directly responsible to us for treatment fees.

You are responsible for any deductible amount, co-insurance, or any balance not paid for by your insurance company. We are not obligated to a fee estimate of treatment plan that is more than 6 months old, or if the insurance company changes its co-payments while waiting to perform treatment.

We offer the following PAYMENT OPTIONS:

Cash or Check

Credit cards: Visa, or Master Card.