|Use it or lose it! Use your dental benefits to maintain your oral health and reduce your out-of-pocket expenses.|
Dental Payment Options
Payment for professional services is due at the time dental treatment is provided unless pre-authorization indicates a specific amount. Every effort will be made to provide a treatment plan fitting your timetable and budget, providing your child the best possible care. Payment options include:
If we receive complete insurance information on the day of an appointment, our office will gladly 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. 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 90 days, a finance charge of 1.5% will be added ot your account each month until paid. We will send a refund to you after receipt of insurance reimbursement.
PLEASE UNDERSTAND that we file dental insurance claims 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 items insurance companies pay on a claim. We can assist you in estimating your portion of the cost of treatment, but we cannot guarantee how insurance companies will handle specific claims. We also cannot be responsible for errors in filing insurance claims because we file claims as a courtesy rather than an obligation.
Fact 1 - NO INSURANCE PAYS 100% FOR ALL PROCEDURES
Dental insurance is meant to be an aid in covering the cost of 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 and some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage and by the type of contract your employer has negotiated 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 inaccurate impression that any fee greater than the amount paid by the insurance company is unreasonable or exceeds what most dentists in the area charge for a certain service.
Do not be mislead by a UCR statement. Insurance companies set their own schedules and each company has a different set of allowable fees. Schedules of allowable fees vary widely because each company collects fee information from claims it processes. An insurance company uses this data to arbitrarily determine "allowable" UCR fees. Frequently, this data is three to five years old and allowable UCR fees are set by insurance companies to ensure a 20% - 30% net profit.
Unfortunately, insurance companies may imply that dentists are overcharging rather than admit that they are underpaying or that their benefits are low. In general, less expensive insurance policies have lower UCR fees.
Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. Assume the fee for service is $150.00. If the insurance company allows $150.00 as its usual customary (UCR) fee, we can figure out what benefits will be paid. First, you must pay the deductible, which is usually about $50.00. After subtracting the $50.00 deductible, $100.00 remains. If your plan pays 80% for a particular procedure, the insurance company is responsible for 80% of $100.00, or $80.00. In this example, the insurance company will pay $80.00 and you will pay $70.00 for the $150.00 procedure. Of course, if the UCR is less than $150.00 or your plan pays only 50%, the insurance benefits will be significantly less.
Most importantly, please inform us of any insurance changes such as policy name, insurance company address, or a change of employment.