Because we are a third-party specialist provider, our services and fees are completely separate from the bill from your dental provider. Southern Comfort Dental Anesthesia is NOT currently enrolled with ANY health or medical insurance provider. Quite a few dental or medical insurance companies have not caught up to Office-Based Anesthesia (OBA) due to it's significant expansion in recent years, and it is possible they do not currently recognize these services for coverage.
For this reason we have made our fees as competitive and straightforward as possible in the current environment, and strive to provide quality services that our patients can afford. These fees are typically less than half the cost of treatment at a surgery center, and can many times be less than 25% of the cost of similar treatment in a hospital.
This does not mean that your dental or medical insurance will not cover these services, only that the responsibility for reimbursement lies with the covered insured (you) and not SCDA. We will be happy to provide any necessary documentation or records that your insurance carriers request or require in the hopes that you will receive reimbursement for covered treatment services.
We strongly recommend and encourage you to contact your dental/medical insurance provider to determine if OBA is a covered benefit of your health plan. If they state that the procedure is NOT covered, ask them why or if there is any documentation required which WOULD make them covered by this benefit. You may need something called a "Letter of Medical Necessity", which you or your child's dental provider should be happy to provide. Some plans specifically disallow reimbursement for hospital charges not related to the surgery or anesthesia, which may leave you on the hook for uncovered services even if the insurer covers these two specific services. We recommend you verify if that charges such as OR time and PACU time are covered services for your procedure.
Below is a link to a potentially helpful guide to dealing with insurance for reimbursement, as well as a reference for understanding how Out-of-Network billing is reimbursed.
Example Of Reimbursement Expectations:
- If your insurance determines they cover general anesthesia provided in the office for your child and you submit for reimbursement
- Most dental plans cover 50% of the allowable* cost of the procedure, with no out of pocket maximum for stand-alone plans and a $375 OOP maximum per child for ACA pediatric dental plans.
*The "allowable" cost of the procedure is determined by your specific insurance, and may not be the same as the charged cost from SCDA.
For a pediatric patient with a $50 deductible (unmet), $375 OOP maximum, a reimbursement rate of 50%, and allowable cost of $950; the expected cost to the patient would be $575 after insurance reimbursement.
: $1100 SCDA Fee - $950 Allowable (150)
: $50 Deductible (50)
: 50% * 950 Allowable (450; however max OOP is 375) (375)
: $150+ $50 + $375 = $575
: $525 if deductible for the year has been met
For a pediatric patient with a $50 deductible (unmet), no OOP maximum, a reimbursement rate of 50%, and allowable cost of $950; the expected cost to the patient would be $650 after insurance reimbursement.
: $1100 SCDA Fee - $950 Allowable (150) : $50 Deductible (50) : 50% * 950 Allowable (450) : $150+ $50 + $450 = $650
: $600 if the deductible for the year has been met