After examining your child we will work with you to develop a treatment plan that respects your timetable and budget while providing your child with the best possible dental care. As a courtesy we will file claims on your behalf if you have all your insurance information. Insurance companies are required to pay claims within 30 days of receipt of the claim. We file claims electronically so your insurance company will receive the claim within days of treatment. Please review your insurance benefits as the portion that is not covered by the insurance company is your responsibility and is due at the time of service. Payment for services is due at the time treatment is rendered. For your convenience, we accept debit cards and most major credit cards. We are also pleased to offer Care Credit to our patients. We DO NOT accept personal checks. Please be aware that the person who brings the child to our practice will be responsible for payment of all charges at the time of service.
It is important for you to know your insurance plan and the benefits they offer, including deductibles and copays. We do not dictate insurance policies and can only work with them to provide you with an estimate to the best of our knowledge. If you have any questions, our staff is always available to answer them.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We ask that you bring your current insurance card with you at each visit. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.
It is very important that you keep us informed of any changes in your insurance including the policy name, company address or a change in your employment.
Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company. We will assist you in maximizing your full benefits, but please understand that your insurance is a contract between you, your employer and insurance company, not our office and your insurance company. The type of plan chosen by you, and/or your employer determines your insurance benefits. As such, we have no say in the selection of your insurance company, no control over the terms of your contract, the method of reimbursement or the determination of your insurance benefits. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. Thus, you are responsible for payment in full of any portion of our fees not covered by your dental plan.
Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.
A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit. Unfortunately, insurance companies imply that your dentist is “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Fact 3 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductible and co-pays must be considered. The following example illustrates how an estimate is calculated:
Fee for service – $150.00 (with the insurance UCR at $150.00)
Deductible paid by you – $50.00
Balance – $100.00
80% of balance paid by insurance – $80.00
Remainder paid by you – $20.00
Under these circumstances you would pay $70.00 out of the total $150.00 fee. If the UCR is less than the fee or your plan pay less the 80% of the balance after your deductible, your portion of the bill will be greater.
Fact 4 – INSURANCE & TREATMENTS NOT COVERED
Insurance companies may disregard the standards of care that have been recommended by both the ADA and the American Academy of Pediatric Dentistry. We occasionally see dental plans that do not cover recommended procedures such as dental sealants, topical fluoride application and even white “tooth colored” fillings. Insurance plans may also limit the frequencies of these treatments. As a result, only part of your child’s treatment will be covered. You are responsible for the full balance including any amount that is not paid by your insurance company.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
In House Plan
We know that not everyone can afford dental insurance. We offer an in-house plan as an attractive and affordable alternative. With our discount plan, you’ll be able to save yourself money. Included in the plan are two cleanings, x-rays, and examinations including emergency exams. You will also receive a set discount on whatever treatment may be needed. All patients are eligible for this exam as long as you’re not covered by an existing dental insurance plan. When you subscribe to our plan, you’ll receive the following benefits:
No monthly premium
No enrollment forms
No annual individual or family maximum allowed benefits
No claims to fill out for reimbursement
No downgraded benefits
No denial of payment for prior treatment
No wait periods
For details please call our office or fill out our online appointment request form. If you have any questions, comments, or concerns, we encourage you to contact us online or by phone. We can’t wait to hear from you!