Terms of Service

1. Overview

These Terms of Service govern your use of the Apex Dental Recovery website and our dental insurance recovery services. By using this website or engaging our services, you agree to these terms.

2. Services Description

Apex Dental Recovery provides contingency-based dental insurance claim recovery. Our core service is the pursuit of claims that have not resolved through the practice's normal revenue cycle, including:

• Denied claim appeals, including direct communication with the carrier, challenges to payment decisions, and escalation
• Requests for reconsideration and reprocessing, with follow-up through to resolution
• Underpayment identification and recovery of the incremental balance owed
• Aging insurance accounts receivable resolution
• Recovery of claims approaching timely-filing or appeal deadlines
• Contracted-rate and fee schedule audits
• Medical-dental cross-coding appeals

We separately provide ongoing accounts receivable and billing services, which are not priced on contingency:

• Insurance claims submission
• Payment posting and EOB reconciliation
• Ongoing accounts receivable follow-up
• Insurance verification and eligibility checks
• Provider credentialing and re-credentialing
• Monthly revenue cycle reporting

Unless an ongoing-support engagement is agreed in writing, Apex Dental Recovery does not replace your existing staff or billing company and does not assume responsibility for your day-to-day revenue cycle. Where an ongoing-support engagement is in place, claims that are paid through the normal revenue cycle are covered by that engagement's fee and no contingency fee is charged on them.

3. Free Recovery Audit

The free recovery audit offered through this website is a no-obligation review of your denied, underpaid and aging insurance accounts receivable. It identifies what we believe is recoverable and states the contingency rate we would charge. Submitting the form does not create a binding service agreement, and no rate is binding on either party until a formal engagement is signed.

4. Pricing and Payment

Recovery work is charged purely on contingency: a percentage of amounts recovered, and nothing if nothing is recovered. Indicative rates, subject to the rate stated in your signed service agreement:

• Claims 30–90 days old, straightforward denials: 20–25% of amounts recovered
• Claims 90–180 days old, or requiring direct carrier intervention: 30% of amounts recovered
• Claims 180+ days old, repeat denials, or underpayments: 35–40% of amounts recovered
• Claims approaching a timely-filing or appeal deadline, or otherwise exceptionally difficult: quoted case by case

Definition of "recovered." "Recovered" means the incremental amount a payer releases as a result of our work on a claim. It does not include amounts already paid on the claim before our engagement, and it is never calculated as a percentage of your total collections. Where a claim was underpaid and we obtain an additional payment, our fee applies only to that additional payment.

Contingency fees are invoiced after the payer has remitted to your practice.

Ongoing AR and billing services are priced separately, on a flat monthly or per-item basis. Contingency rates never apply to them. Indicative rates, subject to your signed service agreement:

• Per item: insurance verification at $2.75–$12.50 per eligibility check, with no monthly commitment; credentialing quoted per application
• Hybrid AR support: $500 per month plus 3% of insurance collections — claims submission, payment posting and EOB reconciliation, ongoing AR follow-up, verification and monthly reporting
• Full-service billing: 5–6% of insurance collections with no monthly base, reducing to 5% above $100,000 per month in collections

Where an ongoing-support engagement is in place, claims paid through the normal revenue cycle are covered by that engagement's fee; no contingency fee is charged on top of it. Specific pricing will be detailed in your signed service agreement.

5. Client Responsibilities

To enable effective service delivery, you agree to:

• Provide accurate and complete practice information
• Grant necessary access to practice management systems as outlined in the BAA
• Respond to information requests in a timely manner
• Maintain active insurance provider contracts for claims we are recovering

6. Confidentiality and HIPAA

We treat all practice and patient data as confidential. Before accessing any protected health information, we will execute a Business Associate Agreement (BAA) in compliance with HIPAA regulations. Our full data handling practices are described in our Privacy Policy.

7. No Guarantee of Results

While we have a strong track record of successful claim recoveries, we cannot guarantee specific outcomes. Recovery results depend on factors including claim validity, payer policies, timely documentation, and insurance contract terms. Past recovery amounts referenced on this website are based on actual client results but are not guarantees of future performance.

8. Termination

Either party may terminate the service relationship with 30 days written notice, unless otherwise specified in the service agreement. There are no long-term contracts or cancellation penalties. Upon termination, we will return or securely destroy all practice data in our possession.

9. Limitation of Liability

Apex Dental Recovery's liability is limited to the fees paid for services in the 12 months preceding any claim. We are not liable for indirect, incidental, or consequential damages arising from the use of our services or this website.

10. Website Use

This website is provided for informational purposes. You agree not to:

• Submit false or misleading information through our forms
• Attempt to interfere with the website's functionality
• Use automated tools to scrape or access the website

11. Changes to These Terms

We may update these terms from time to time. Changes will be posted on this page with an updated revision date. Continued use of our website or services after changes constitutes acceptance of the updated terms.

12. Contact Us

If you have questions about these terms, please contact us:

Apex Dental Recovery
Email: info@apexdentalrecovery.com