Oral Surgery Insurance Information
At Capital Oral & Facial Surgery, serving our patients is our highest priority. While there are many benefits to processing with an insurance company, such as discounts, the process can often be time-consuming and confusing. Below are the three main steps in the insurance claim process:
Claim Submission
Claims are submitted on the day of your surgery. The insurance company typically takes 60–120 days to process and provide an Explanation of Benefits (EOB). However, in some cases, processing may take more than six months.
Claims Reception
Once we receive the insurance payment and EOB, our team will apply the payment to your account. Adjusting balances or calculating refunds takes time, possibly up to 30 days.
Refund Processing
A third-party administrator audits and processes refunds to ensure accuracy and security. This involves gathering necessary details, such as names, addresses, and refund amounts, and mailing refunds securely. Refunds are processed monthly, and this step can take up to 30 days.
The usual timeline from receiving the EOB to issuing a refund check is 60–90 days (steps 2 and 3).
Important Note on Delays
Occasionally, insurance companies may make processing errors (e.g., incorrect coverage processing errors), leading to delays. To minimize these issues, every claim is carefully reviewed by our team and a third-party auditor. Your timely refund is our utmost priority
Filing with Secondary or Medical Insurance
If you choose to file with medical insurance or secondary insurance, please note this may significantly delay the processing of your claim—by up to one year.
We appreciate your understanding and cooperation throughout this process. If you have any questions, our team is here to assist you.