After careful consideration, effective January 1, 2024, we’ve made the decision to opt out network participation with commercial medical insurance plans, to include, Medicare and Medicaid. We will remain in network with most dental plans.
WHAT DOES THIS MEAN FOR ME SPECIFICALLY?
If you have commercial insurances, we will continue to bill and pre-authorize treatment as we always have. If your insurance plan has out of network benefits, Seattle Jaw Surgery will collect 50% of consultation, office visits, and surgical fees at the time of appointment. Patients with no out of network benefits should plan to pay 100% of consultation, office visits, and surgical fees at the time of appointment. Once insurance has resolved your claim, we will issue a statement for any remaining amount due or refund any overpayment.
WHY ARE YOU MAKING THIS CHANGE NOW?
After COVID, healthcare is a different place, and hospital access for elective jaw surgery is more difficult. There are just not enough expert providers who perform orthognathic and or TMJ surgery. It was not sustainable to continue care at the same volume as before. This change is necessary to uphold our commitment to our practice philosophy, providing you with the best care possible.
WILL YOU BE OUT OF NETWORK WITH MY DENTAL INSURANCE AS WELL?
Great question! Seattle Jaw surgery will remain in network providers with the following commercial dental plans: Delta Dental, United Concordia, Premera, Cigna, MetLife, and Guardian. We will bill most other commercial dental plans as well. We will no longer be in network with Medicaid/Medicare dental plans and will no longer bill them.
WILL IT COST ME MORE?
If your insurance plan offers out of network coverage, you should be prepared to pay 50% of the consultation appointment cost at time of check-in. We accept all major credit cards, Care Credit, Money orders, and Cashier’s Checks as methods of payment. We will bill your insurance as an out of network provider and any reimbursement to you will come from your insurance company directly. You may see changes in your coverage and out-of-pocket expenses.
WHAT IF MY PLAN DOES NOT HAVE OUT OF NETWORK BENEFITS?
Patient costs for outpatient surgeries fall into 3 categories- Professional (surgeon) fees, Facility (hospital) fees and Anesthesia fees. You can still utilize in-network benefits for Facility and Anesthesia fees. If you do not have out-of-network benefits and otherwise healthy we can offer the opportunity to have procedures done in our office. This will eliminate the facility and outside anesthesia fees. We recommend reaching out to your insurance provider or employer directly and asking about any potential changes in your coverage, as well as confirming the benefits you are eligible for.
