At Dr. Charles S. McElfish, PLLC we make every effort to provide you with the finest care and the most convenient financial options. To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date. They can be reached by phone at (304) 726-4562.
Please call if you have any questions or concerns regarding your initial visit.
Please bring your insurance information with you to the consultation so that we can expedite reimbursement.
We accept all standard indemnity plans and are in network with the following PPO plans:
- Delta Dental
- United Concordia PPO (we do not participate with the DHMO plan)
- Highmark BlueCross BlueShield of West Virginia
- CareFirst BlueCross BlueShield
- Cigna PPO / CignaPlus Savings Program
- The Guardian (DentalGuard Preferred Select Network)
- Humana PPO/Traditional and HumanaDental Medicare
- DenteMax Network
- Stratose Dental Network
- Connection Dental Network
- Dental Health Alliance, LLC (Assurant Employee Benefits)
- Zelis Dental Network
We do not participate in any Medicare or Medicaid plans.
Electronic Claims
Our office utilizes electronic claims processing. This means that rather than sending your dental claim through the mail, it is sent electronically to your insurance company with the click of the button. By filing your claim electronically, information is submitted more efficiently and with fewer errors. This benefits our patients because the turnaround time on claims is faster and fewer claims are returned or denied. We are happy to submit your dental claims to your insurance company on your behalf.
Please be aware that some dental insurance companies take longer than others to complete payment. If necessary, our office will contact the dental insurance company, or we may request your help in this matter.
What is Dental Insurance
Dental insurance is a contract between your employer and a dental insurance company. The benefits that you will receive are based on the terms of the contract that were negotiated between your employer and the dental insurance company and not your dental office. The goal of most dental insurance policies is to provide only basic care for specific dental services. The services selected are based on the cost of the policy to your employer and the negotiated arrangements with the dental insurance company.
The benefits you receive from the dental insurance company for your current insurance plan have nothing at all to do with you or achieving a high quality complete result.
Because the benefits you currently have are decided between your employer and the insurance company, many services are not covered. The selection of non-covered services is not based on what you need or want, but is based strictly on the contract with the insurance company.
This is why so many dental patients become confused about dental insurance. Dental insurance companies rarely cover 100% of any dental fee and, in many cases, cover less than 50% or nothing at all.
Covered and Non-Covered Services
Unfortunately, some of the services that you may need or want will not be covered by your dental insurer. Our goal is to help you achieve and maintain optimal dental care, which is not necessarily the goal of your insurance company. The goal of the insurance company is to provide only the negotiated benefits for the specifically selected services.
The reimbursement mechanism from your dental insurance company is merely a mathematical formula as to which benefits you will receive and the percentage of the dentist’s office fee that will be paid. We do not want to compromise your care based on the constraints placed by an insurance company.
Another fact that most dental patients do not realize is that each dental insurance plan has a dollar amount limitation each year. Once this limit is reached, no other service will be covered by your dental insurance company regardless of how essential the service may be to your dental health.
Pre-Treatment Estimates
Many insurance companies try to control the amount of dentistry you receive by requiring authorization for procedures in advance. Our office will do everything possible to help maximize the insurance benefits to which you are entitled.
In most cases, we can begin treatment prior to receiving an authorization from the dental insurance company. However, patients need to understand that in the event the dental insurance company refuses to pay for treatment, you are responsible for all fees. Naturally, we always provide you with full fees in advance so that you know the exact treatment cost.
Elective Treatment
Some services are typically not covered by dental insurance companies. These include: cosmetic dentistry, implants, occlusion or bite redesign, and other services. Although these are important dental services that can greatly enhance the quality of life of our patients, dental insurance companies do not feel that they should have to pay for these services. That is why these services are rarely included in contracts with your employer.