How are appointments scheduled?
Our 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 extensive treatment needs 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 48 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.
We do make every effort to honor all time commitments by remaining on time for scheduled appointments. However, our office does work exclusively with children, and unexpected situations do arise in which a child may require more individual time and attention than planned. This same courtesy will be offered to your family.
You are welcome to accompany your child during his or her dental appointments. We do request that young children who may distract your child not be brought into the examination and treatment rooms. For the safety and privacy of you, your children, and all other patients, children who are not being treated should remain in the reception room with a responsible supervising adult.
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. For those families choosing to extend payment over an extended time with our office, a payment plan can be arranged that will coincide with your child's treatment. Our office participates in the Care Credit program.
There are many insurance companies that provide dental insurance benefits for businesses and employees. Most of these insurance companies offer multiple individualized plans tailored to meet the needs and desires of individual businesses and families. The cost of the plan to the employer may often be a concern, and less expensive plans are likely to offer less benefits to the families enrolled in these plans. Most dental offices work with hundreds of individualized insurance policies which each have a different set of benefits and limitations. These policies are likely to be updated annually and may change every year. Since dental offices do not have access to individualized insurance policies, we strongly recommend that each family be familiar with the benefits and limitations of their individual insurance policy.
Also, with the new Affordable Care Act (ACA) and its focus on pediatric dental care, there are numerous new dental insurance policies for children. Some of the new dental insurance policies may only be contracting with a limited number of dental offices. Therefore, these insurance companies may restrict a family’s choice of dentists for their child or children by refusing to pay for care unless you have certain selected dentists provide your child’s care. You are likely to find that most pediatric dentists are not included in your insurance company’s list of “preferred provider” dentists for children. Surprisingly, some new dental insurance policies have been found to offer no benefits even for routine check-up appointments, resulting in all costs being “out of pocket” for the family.
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. Our office works with numerous companies, each of which may offer numerous plans and levels of coverage with variable benefits selected by employers. Each of these plans may change annually. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. You should expect that your insurance company will pay each claim within 30 days of receipt. We file all insurance claims promptly, 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. For balances unpaid within 60 days, a monthly re-billing fee of 1.5% will be charged to the account. We will be glad to send the insurance check or a refund to you if your insurance pays us.
Our office works with all dental insurance companies, and we accept payment from all types of dental insurance. However, we are not considered “preferred providers” for any insurance company because we have not agreed to participate with any discount insurance program. Essentially, to be on an insurance company’s list of preferred providers, the training, the skills, and the experience of a dentist seem not to be what is the most important. Most insurance companies do not evaluate the quality of care offered by dentists in order to be accepted into the insurance company’s program. Instead, to be on an insurance company’s list of providers, the dentist must agree to follow the insurance company’s guidelines and limitations of care, the dentist must agree to accept the payment from the insurance company as “payment in full,” and the dentist must agree to “hold the insurance company harmless” if there is a bad outcome as a result of the dentist following the insurance company’s guidelines for care. Since our responsibility is to your child and not the insurance company, we are intentionally not on any insurance company’s list of “preferred providers”.
We do review our fees on an ongoing basis, and we see that our fees are at or below the UCR of numerous insurance companies because we often see that the insurance company has paid our full fee. Also, we know our fees are within the range of dentists in our area. As a matter of fact, we are also aware that our fees are even lower than some local general dentists, family dentists, and cosmetic dentists who treat children yet have no specialized training working with and/or treating children.
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.
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. Preventive services to maintain your good dental health are frequently covered at a much higher percentage than restorative services to repair damaged or decayed teeth.
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. Most, if not all, insurance companies have multiple UCR schedules that may be utilized under different circumstances or for different dental offices based on their location. Our office is aware that some insurance companies have multiple different UCR schedules that are used just for our practice.
Insurance companies set their own UCR 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. The UCR information we receive along with the “Explanation of Benefit” (EOB) statements reveals that different insurance companies do not even use the same UCR schedules for our office.
Unfortunately, insurance companies may 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 our office updated if there is a change of employment, change of insurance coverage (company or plan), policy number, employee ID number and insurance company address.