Practical Matters

Insurance Information

Please remember:

Your insurance is a contract between you and/or your employer and/or the insurance company. We are not a party to that contract. Questions regarding why your company includes or excludes certain services should be directed to your employer.

Our fees are based on your individual needs and what doctor Silberg feels will be required to provide the highest quality care. The exact amount of reimbursement will vary between insurance companies. Some companies reimburse based on an arbitrary “schedule” of fees, which has no relationship to the current standard, and cost of your care.

Insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures, and others pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance or any other balance not paid for by our insurance.

Your insurance coverage may or may not include benefits for services provided in this office. The benefits you may receive are established by the terms of the contract that has been purchased by your employer or you. The formula your insurance carrier uses, if benefits are covered, may be less than the fee we have established as necessary for your care.

There are several ways benefit amounts are determined:

  • Some plans pay a set dollar amount for service.
  • It is common for a plan to pay a percentage of what the insurance industry calls the usual, customary or prevailing fee. Each insurance carrier establishes their own usual, customary and prevailing fees by use of a complicated formula, which is confidential and not made public. In our view, usual and customary is an insurance term that means, “average care”. The care we provide is designed to be excellent rather than average.
  • Many policies require that an annual deductible be paid. Amounts range from $25 to $250.
  • Most plans set an annual or lifetime limit on benefits.
  • Very few insurance companies require a pre-treatment estimate. We will prepare one if it is important for you to understand what your financial obligation will be. We charge a $35 fee to process the paperwork and if you complete that care, the fee will be credited back to your account. The insurance company will notify you or us as to what benefits they will pay. Please review your insurance booklet thoroughly and be sure to ask questions of your company’s representative so that you do not have “surprises” when you are asked to meet your financial obligations. We are prepared to assist you as much as possible. At times we are unable to help due to contractual limitations or interpretations by the insurance carrier.

Filing insurance claims is a courtesy that we extend to our patients. All charges are your responsibility from the date the services are rendered. If a temporary financial problem will effect timely payment of your account, we encourage you to contact us promptly for assistance in the management of your account.