Payment for dental services is due at the time treatment is provided. Every effort will be made to design a treatment plan that gives your child the best possible care, and fits into your timetable and budget. We accept cash, personal checks, debit cards, and most major credit cards.
OUR OFFICE POLICY REGARDING DENTAL INSURANCE
If we have received all your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, because we will collect from you the estimated amount insurance is not expected to pay.
By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment.
You are responsible for any balance on your account after 30 days, whether insurance has paid for it or not. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until the outstanding balance is paid. We will be glad to send a refund to you if your insurance pays us.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company. 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 do not guarantee what your insurance will or will not do with each claim.
FACT 1 — NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients assume their insurance pays 90 to 100% of all dental fees — this is not true. Most plans only pay between 50 to 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 your insurance company.
FACT 2 — BENEFITS ARE NOT DETERMINED BY OUR OFFICE
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 is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees it regards as reasonable. These reasonable fees may vary, because each company collects fee information from claims it processes.
The insurance company then takes this data and arbitrarily chooses a level it calls the “allowable” UCR fee. Frequently, this data can be three to five years old and the fees are set by the insurance company so it can net a 20 to 30% profit.
Unfortunately, insurance companies imply that dentists are overcharging, rather than say they are underpaying, or their benefits are low. In general, the less expensive insurance policy will use a lower reasonable (UCR) figure.
FACT 3 — DEDUCTIBLES AND CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume a service fee is $150.00. If 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 averages $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.
MOST IMPORTANT, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.