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.
Please provide us with ALL dental insurance information that your child is associated with (insured name, member/subscriber ID number, carrier/company name, plan name, group number, date of birth for patient and member/subscriber, Social Security Numbers of each, etc.). All of this information will be required to determine coordination of benefits or which one becomes primary. NOT PROVIDING ALL INSURANCE INFORMATION AND RETAINING SAID INFORMATION WILL BE CONSIDERED FRAUD, AND PARENT WILL BE RESPONSIBLE IN FULL. Absolutely, no retroactive filing of claims will be allowed.
If the child has 2 or more Commercial/Private/government Insurances: After your primary dental insurance has made its payment to us and sent you an EOB (Explanation of Benefits), you may bring your EOB to our office. At this time we will provide an ADA claim form for you to send to your secondary insurance, but we will no longer be responsible for this step in filing any claims.
Both Medicaid/CHIPS and Commercial/Private Insurances: We will not file Secondary Medicaid. You must still tell us and also tell Medicaid about your other private insurance. If you give us a letter directly from that insurance stating that coverage has terminated/inactivated with a term date, then our office could file your Medicaid as primary insurance. If this information is not provided by the legal parent or guardian the amount due will become the parent’s legal responsibility; we will no longer be filing Medicaid as a secondary insurance. No exceptions!
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment. We will only file claims to your Primary Insurance carrier, but we need to know about all your active dental insurances to file correctly.
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.
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.
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.
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.
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.
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.
If you have 2 commercial or private insurances, please give us all the information of every active insurance your child may be on. It will be used to determine the coordination of benefits with each other. For treatment appointments, you will be responsible for paying a deposit to schedule treatment and your remainder patient portion on the date of service. After the claim, has paid and sent you a paper Explanation of Benefits (EOB), you may bring to our office the paper EOB of your private Primary carrier and ask us for a printout of your dental codes on an ADA claim form so that you can file with your secondary insurance carrier.
If you have private commercial insurance and a Medicaid plan for your child, will also no longer file to the secondary, which is the Medicaid plan. The primary insurance carrier will be the only one that can pay for your child, because Medicaid will never be filed. Medicaid needs to know you have other health insurance (OHI). If you private insurance is no longer active, you will need to sign a letter that will be sent to Medicaid acknowledging that you no longer have active OHI. You will be responsible for the deposit to schedule an appointment and the remainder patient portion due on the day of service.
If you only have a Medicaid plan and you are requesting a non-covered benefit, then you can fill out a Non-Covered benefit form and be responsible upfront for the cost. We will not bill Medicaid. If insurance is no longer active, you may sign a letter that says it is no longer active to send with the claim to Medicaid.
Please ask your employer’s Human Resource (HR) department about the plan they have selected for you. Consistent with our ongoing efforts to be a paperless office, we have begun eliminating paper statements this year to the extent possible, unless you request it.