What about finances?
Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives your child the best possible care. We accept personal checks, debit cards and most major credit cards. Additionally, we offer easy interest-free payments plans through CareCredit. Please let us know if you would like more information.
Please be aware that the parent and/or guardian who brings the child to our practice will be responsible for payment of all charges at the time of service.
Our Office Policy Regarding Dental Insurance
We accept check, major credit cards, and dental insurance. Payment for your portion of the treatment that is not covered by your insurance is due at the time of treatment. The parent or guardian that brings the child to the appointment is legally responsible for payment. We do participate with Care Credit as an easy way for our patients to obtain financing for treatment.
Please bring your current insurance card to each visit. As a courtesy to our patients we will accept assignment of benefits from your insurance carrier which means that we will accept payment from your insurance carrier and ask that you only pay your estimated portion at the time of the appointment. You can help us by familiarizing yourself with your insurance coverage since benefits vary among plans. 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.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. There is no direct relationship between 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 do not have a contract with your insurance company, only you do. 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.
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.
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.
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, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that
the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.
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.