OUR OFFICE PARTICIPATES IN:
- Anthem Dental Blue
- Cigna PPO
- Delta Dental
- United Concordia
- Washington Dental
Due to the nature of insurance plans, your plan may not be included in our accepted networks. Be sure to call before your visit to verify and clarify.
PAYMENTS AND INSURANCE
Payment for our professional pediatric dentistry services is due at the time treatment has been provided. We make an effort to create treatment plans that fit each family’s budget and timetable while providing the best possible care for your child. We accept cash, personal checks, debit cards, and most major credit cards for our pediatric dental services.
Please be aware of these policies regarding INSURANCE:
- If we have been provided with all your insurance information on your appointment date, we will gladly file your claim for you.
- Be sure to familiarize yourself with your insurance benefits because we will collect from you the amount that your insurance is not estimated to cover.
- We file all insurance electronically so that your insurance company will be notified of each claim within days of your child's appointment with us.
- Within 30 days of the receipt, your insurance company is legally bound to pay each claim. After those 30 days, you are personally responsible for any balance remaining on your account. This stands regardless of your insurance having paid or not.
- If your balance has not been taken care of within 60 days, we will add a re-billing fee of 1.5% to your account each month until the balanced is covered. If your insurance does pay our pediatric dentist office after you have made the payment, we will be happy to issue a refund to you.
It is important to understand that we do not have a contract with any insurance company. We remain non-responsible for how your company handles claims and what benefits your company is willing to pay on a claim. Therefore, we cannot guarantee what an insurance company will do with each claim filed. We are only able to assist in estimating what your cost of the treatment will be. Please remember, we file claims as a courtesy to our patients.
DENTAL INSURANCE BENEFITS
Please be aware that our office DOES NOT determine dental insurance benefits. On occasion, a dental insurer will reimburse its clients at a lower rate than the dental office's actual fee. In such cases, a company will likely state that the reimbursement was reduced due to the dentist's fee having exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. Don't let that scenario give you the impression that any fee larger than the amount covered by an insurance company is unprecedented, or any higher than what other pediatric dentist offices in the area would charge for any given service. The scenario is misleading and the impression inaccurate.
An insurance company will set its own schedule and have its own set of fees that they consider to be acceptable, which are often different than those of other companies. Due to each company collecting information from claims, the fees can actually vary a great deal. After collecting information, the insurance company uses the data received to choose a level they decide to be acceptable by their own standards. This is the UCR fee. The data used can often be from 3-5 years prior to the service date, which allows an insurance company to accumulate a 20%-30% profit.
Insurance companies will unfortunately give their clients the impression that the pediatric dentist is “overcharging” instead of admitting that their company is “underpaying” or simply that their benefits are low. Typically a less expensive insurance policy will use a lower UCR figure.
COVERAGE OF FEES
Many of our patients think their insurance pays 90%-100% of all dental fees. This isn't true! It's important to know your insurance benefits for that reason. The intention of dental insurance is to be an aid so you may better afford dental care. Most plans pay between 50%-80% of the average total cost. The percentage your insurance company is willing to pay depends on the type of contract you or your employer has set up with the company.
DEDUCTIBLES AND CO-PAYMENTS
Please be aware of your benefits, deductibles and co-payments when you plan your child’s visit. For your reference, you can consider this scenario:
If the fee for an appointment is $150, we will assume the insurance company allows $150 as the UCR. We will then estimate the benefits to be paid. The deductible is considered first in the process, normally around $50 (paid by the patient). The $50 is then subtracted from the balance owed. The plan between the insurance company and the client is that 80% will be paid. The insurance company then pays 80% of $100, or $80. Not 80% of $150. This means the patient will pay $70 total. If the UCR is less than $150, or if the plan is set to pay only 50%, then the insurance benefits received will, of course, be significantly less.
REMEMBER to keep us updated on any changes regarding your insurance, including policy name, insurance company address, or changes in employment.