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How are appointments
scheduled? |
Do I stay with my child during
the visit?
What about finances?
| Our Office Policy Regarding
Dental Insurance
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 effectively with
them for their comfort. School children with a
lot of treatment 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 situations may arise,
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, Care Credit and most major credit cards.
If we have received all of
your insurance information prior to or 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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