Our pediatric dental services are considered “out of network” with most PPO plans. Please check with our front desk staff for detailed information on whether our services are considered in-network with your particular plan. It is our pleasure to submit your claims electronically. In order to do this we need all pertinent insurance information by your child’s first appointment. If you do not have the insurance information, you will need to pay for services rendered that day and your insurance company will reimburse you. Please note that we will file your insurance for you and follow up on claims for 60 days.
After this point, following up on claims and paying the remaining balance becomes your responsibility. We ask that you realize that we do NOT work for an insurance company. Rather, we work 100% for our patients. We feel that insurance can be a great benefit for many patients and want you to know we will do everything in our power to ensure you get every benefit allotted in your insurance contract. However, the treatment we recommend and the fees we charge will always be based on your child’s individual needs, not your insurance coverage. We file insurance as a courtesy to our patients. It is important for you to be familiar with your insurance benefits. We are more than happy to assist in estimating treatment plans for your child, but remember they are only estimates.
The top three misunderstood facts regarding dental insurance are:
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. 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.
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.
What About Finances?
Payment for dental services is due at the time 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, and all major credit cards. For more extensive procedures, a payment plan can be set up through Care Credit an independent finance company that allow for monthly payment plans.