Notice of Privacy Practices
Please read our HIPPA Notice of Privacy Practices here
We are committed to providing your child with excellent dental care. Our convenient financial arrangements are based on an open and honest discussion of recommended treatment options, respective fee and patients’ financial capabilities. Payment in full is due at the time of service unless prior financial arrangements are made.
Our Office Policy Regarding Dental Insurance
Our office is committed to helping patients maximize their dental benefits. Because insurance policies vary greatly, we can estimate your coverage, but cannot guarantee it. As a courtesy to our patients, we will be happy to file your claim to insurance for you. Please call the office if you have questions regarding in and out of network status of your particular dental insurance plan. In many cases, we do not see a significant difference in the out of pocket costs with our patients who are considered out of network. We are happy to help navigate this with you.
Here are a few hints that may help in understanding how dental insurance works.
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 your insurance company.
Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
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 is not accurate.
Insurance companies set their own schedules, and each company uses a different set of fees they consider reasonable. These reasonable fees may vary, 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 fees are set by the insurance company so they can net a 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 reasonable (UCR) figure.
Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume a service fee 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 averages $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.