Payment for professional services is due at the time dental treatment is provided. We accept cash, personal checks, and Visa/MasterCard/Discover. In an effort to help provide your family more flexible financial options, we accept CareCredit. We also will be happy to submit insurance claims to your insurance company, but please keep in mind that our office is considered an Out-Of-Network provider for all insurance plans. If we do not have an accurate estimate at the time of check-out, we will require a $35 co-pay.
Our Office Policy Regarding Dental Insurance
If we have received all of 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, as we will collect from you the estimated amount insurance is not expected to pay at time of service. 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 45 days, whether insurance has paid or not. A re-billing fee of 1.5% will be added to your account each month until 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, only you do. 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.
FACT 1 – No insurance pays 100% of all procedures.
Dental insurance is meant to be an aid in receiving just 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 they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use the lower usual, customary, or 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 the fee for service is $150. Assuming that the insurance company allows $150 as its UCR fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100, or $80. Out of a $150 fee they will pay an estimated $80 leaving a portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays 50% then the insurance benefits will also be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes as soon as possible, such as policy name, insurance company address, or a change of employment as soon as posible. This will prevent interruptions to your child’s care.