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Insurance |
How are appointments
scheduled? |
Do I stay with my child
during the visit?
What about finances?
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Our Office Policy
Regarding Dental Insurance
Insurance
We participate with Delta Premier, United Concordia Elite, Cigna PPO, and Aetna PPO.
We will gladly submit any insurance for our patients whether they are in or out of network. Please just make sure that your insurance has an out of network benefit if you do not have an insurance that we are in network with. Most insurances, whether in or out of network pay 80-100% of our fee for regular 6 month check-ups.
If you have any questions regarding your insurance plan please don't hesitate to call us. We are more than happy to answer any questions you may have.
How are
appointments scheduled?
The office attempts to schedule
appointments at your convenience and when
time is available. Preschool children should
be seen in the morning because they are
fresher and we can work more slowly with
them for their comfort. School children with
a lot of work to be done should be seen in
the morning for the same reason. Dental
appointments are an excused absence. Missing
school can be kept to a minimum when regular
dental care is continued.
Since appointed times are reserved
exclusively for each patient we ask that you
please notify our office 24 hours in advance
of your scheduled appointment time if you
are unable to keep your appointment. Another
patient, who needs our care, could be
scheduled if we have sufficient time to
notify them. We realize that unexpected
things can happen, but we ask for your
assistance in this regard.
Do I stay with my
child during the visit?
We invite you to stay with your child
during the initial examination. During
future appointments, we suggest you allow
your child to accompany our staff through
the dental experience. We can usually
establish a closer rapport with your child
when you are not present. Our purpose is to
gain your child's confidence and overcome
apprehension. However, if you choose, you
are more than welcome to accompany your
child to the treatment room. For the safety
and privacy of all patients, other children
who are not being treated should remain in
the reception room with a supervising adult.
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 cash, personal
checks, debit cards and most major credit
cards.
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. 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 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 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 can
not 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.
MOST IMPORTANTLY, please keep us informed
of any insurance changes such as policy
name, insurance company address, or a change
of employment.
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