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 slowly with the child for their comfort. School children with a lot of work 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 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 invite you to stay with your child during all cleaning and restorative appointments. Many pediatric dental practices encourage or even insist that parents wait in the reception area while their child is being seen. Our philosophy is quite the contrary. We believe that helping parents raise healthy smiles is a partnership between you and your children and our dental team. Communication to both parent and child about their total oral health is key to averting future complications and building great dental habits for life. For this reason we love the opportunity of talking with you and your children together at their appointments.
Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan that 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.
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. 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. Below is a list of important facts to understand about dental insurance.
Fact 1 - DENTAL INSURANCE PLANS ARE DESIGNED EXTREMELY DIFFERENTLY THAN MEDICAL INSURANCE PLANS
Dental insurance benefits differ greatly from traditional medical health-insurance benefits and can vary quite a bit from plan to plan. Where medical insurance was designed with the intent of covering the majority of costs, dental insurance was designed as a supplemental aid to the individual’s costs. When dental insurance plans first appeared in the early 1970’s, most plans had a yearly maximum of $1000.00. Today, most plans still have an annual maximum of $1000.00. Over the past 40 years, the premiums have certainly increased yet the benefits have not increased. Allowing for a conservative 6% rate of inflation, your yearly plan maximums should be in excess of $5,000.00 today. Your premiums have increased, but your benefits have not. Therefore, dental insurance is never a pay-all. Instead we must think of it as a great aid only.
Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
Dental insurance is a contract between your employer and a dental insurance company. The benefits you receive are based on the terms of the contract that was negotiated between your employer and the dental insurance company. At times, the benefits negotiated do not align with the dental needs of the patient. In fact, even within an insurance company, like Metlife, there are several different types of plans for your employer to choose from. We pride ourselves in our endeavor to help you maximize your benefits, without allowing the insurance company to mandate the dental services provided to your child. An example of this would be the suggested provision of topical-application fluoride during your child’s preventative care visit. Our doctors, the American Association of Pediatric Dentistry as well as the American Dental Association recommend topical fluoride for children 2 times per year. Most insurance companies, however, in an effort to reduce costs, only allow it 1 time per year. We would not want to cheat your child out of proper care (and an effort to reduce decay) by not providing fluoride 2 times per year just because the business office of the insurance carrier has decided to not provide that benefit to you. Instead, our policy is to inform you of the medical based importance of this recommended procedure and then allow you to make the decision which best fits your family’s needs. We believe an informed decision is always a better decision.
Fact 3 - UNDERSTANDING INSURANCE CLASSIFICATIONS OF “UCR”
You may have noticed that at times, your dental insurer reimburses you or the dentist 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. What exactly does this mean? A statement such as this gives the impression that any fee greater that 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. We prefer the term “Insurance allowable fee structure” as it is more accurate and not misleading as the term “Usual, customary, or reasonable – UCR – is. Insurance companies set their own schedules and each company uses a different set of fees they consider “allowable”. These allowable fees may vary widely and have a broad basis upon which they are set by the insurance companies. In most cases, the “allowable” fees are set about 30% below actual industry standard so that the insurance company can make the profit they need in order to operate. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Fact 4 - 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.
Does it feel like you need a college degree in mathematics and logic to figure out your portion of your dental bill, whose office you can go to, or what procedures are covered by your policy? If you’ve answered yes, you are not alone. We receive 100’s of questions per week relating to these issues and more. Our knowledgeable staff can help you understand & maximize use of your dental insurance benefits. It’s important to understand your policy, and the choices your employer may be giving you so that you can make the best decision possible in behalf of your dental needs. Following is a guide to the differences in the major groups of dental insurance policies and benefits commonly offered to employees. There are basically 5 groups of policies available to us all. Most dental insurance providers offer a choice of policy matching each group. As is true with most things in life, each policy comes with a different price tag to the purchaser of the policy (usually your employer). The greater the premium, the greater the benefits to the members. The insurance carriers may refer to their policies by various names…for ease of consistency we’ve identified them under commonly used descriptors:
Traditional Dental Insurance: This type of policy allows you to go to any dentist in the country (You do not have to pick from a list of dentists provided in a book from the insurance company). Most dental offices now offer to submit your insurance claim for you. For the few who don’t, you can pay for your appointment in full yourself, then submit the receipt with a claim form to receive due compensation from the insurance company. Most dental insurance carriers stipulate an initial deductible to be paid by the member. (Commonly $50.00). Oftentimes, the deductible is waived for preventative care (cleanings, fluoride, exams and x-rays). The ‘deductible’ applies the first time the member uses his/her benefits for ‘restorative or operative’ treatment (fillings, crowns, root canals, etc). This means the member would need to pay the first $50.00 of that treatment. Most policies are structured to cover a percentage of the treatment being done, expecting the member to cover the remaining percentage. Insurance companies have grouped different types of procedures into 3 commonly recognized benefit levels: Preventative care (cleanings, fluoride, exams, x-rays and sealants); Basic restorative care (fillings, simple extractions, children’s pulpotomies [root canals on baby teeth], children’s stainless steel crowns); and Major restorative care (adult root canals, adult crowns, bridges, complicated extractions). As an example of their percentage breakdown of benefits, they may cover ‘preventative’ procedures at 100% (no cost to the member), ‘restorative’ procedures at 80% of the proposed fee (leaving 20% to be covered by the member) and ‘major’ procedures at 50% of the proposed fee (leaving the other 50% to be covered by the member). This is the most costly policy offered but offers the member the greatest extent of benefits.
PPO Dental Insurance: This type of policy is similar to the traditional dental insurance in structure but adds a choice to the policy holder. The member has the choice of using a contracted, ‘in-network’ provider or using an ‘out of network’ provider. The difference to the member is usually about a 10% difference in dental coverage benefits (10% less when going to an out of network provider). Most dental specialists like orthodontists, pediatric dentists, oral surgeons, etc do not contract as ‘in-network’ providers so realizing that you can still see the specialists and utilize 90% of your potential insurance benefits is a great asset. A lot of larger employers offer PPO plans as one of the choices to their employees. This is a great choice for all of your family’s dental needs.
EPO Insurance: These plans mandate that the member use a dental provider on the list only. The goal of these policies is to provide basic dental care to the members. Because of this, these policies usually don’t provide provisions for specialists as mentioned above.
These plans are commonly structured differently from a PPO plan in that the member pays a specifically identified co-pay for most individual procedures according to a fee schedule negotiated by your employer. At times, these “co-pay” amounts may be greater than the 20% coinsurance (for example, for restorative treatment) expected under a PPO plan. It is important to understand this because although the monthly premium may be lower (thus initially making these plans look more attractive to choose), the member may commonly pay more out of pocket upon use of the benefits. Since children in general are at greater risk of tooth decay than adults, we usually recommend to family’s with young children to “choice up” to the PPO plan whenever possible. We have found most family’s with children come out financially ahead over the course of a year by doing so. In addition, since this type of policy usually does not provide provisions for specialists, family’s on this plan commonly do not have good access to pediatric dentists (particularly important if you have children aged newborn to 10 years old). For more information of the differences and importance of using a pediatric dentist, please click here. In general, this is one of the least expensive types of policies to acquire so one must weigh the benefits to the cost.
Discount Plan: This newer concept for dental coverage simply provides the member with a percentage discount across the board for all dental procedures (for example 25% off of all fees). The member is responsible for paying the remaining 75% of their dental bill. There is no deductible and no claims are filed with an insurance company. The dental office commits to providing the discounted fee. This is often a great solution for ‘self-employed’ families who do not have access to group dental insurance. We partner with 2 discount plans: Ameriplan and NHCD.
Fee Schedule: Unlike traditional insurances which pay a percentage of the dentist’s fees, a plan that pays on a Fee Schedule pays a nominal, set dollar amount for each procedure code. Your insurance company will give you a copy of this schedule upon request.
Oftentimes, employers allow their employees to pick the policy they wish to have, requiring the employee to pay the difference in the premiums. Weighing your options becomes an important consideration. Feel free to call our office for a personal insurance consult to help you pick the policy right for you.