Financial & Insurance

 
 

 Our policies were designed with you in mind.

 

Payment Policies

No matter what kind of insurance you have, we will work with you to establish an affordable treatment plan for your child(ren) that provides optimal results.

Payment is due at the time of treatment. Our office accepts cash, personal checks and most major credit cards, and we provide financing through Care Credit.

 

Insurance Information

We are providers for Delta Dental, Medicaid and MetLife Dental. If you have another insurance provider, please bring your card to your child’s first visit. We will be happy to file your claim.

 

Benefits and Claims: We will make every effort to ensure your child receives the maximum benefits allowed under your plan, though we ask that you please familiarize yourself with your insurance benefits. Co-pay is due on the day of treatment.

Once your insurance company receives a claim, by law the claim must be paid within 30 days. Since we file claims electronically, your insurance should receive it within days of treatment.

Because we are not contracted with your insurance company, we are not responsible for how your insurance company chooses to handle claims or what benefits they pay. We can only provide an estimate of your portion of the cost for your child’s treatment. At no time can we cannot guarantee what your insurance will do with the claim. We cannot be held accountable for any errors in filing your claim. We only file claims as a courtesy to you.

Balances: Please remember, our relationship is with you, not your insurance company. If there is a balance on the account after 30 days, you are responsible for paying this amount, whether insurance has paid or not. If you do not pay the balance within 60 days, we will add a 1.5% finance charge to the account each month until the balance is paid. We’ll reimburse you when your insurance company pays us.

 

 Three Facts About Dental Insurance

 

Fact 1 – No Insurance Company Pays 100% Of Fees

The purpose of dental insurance is to help pay for care. Many parents assume that insurance will pay 90-100% of all fees, but this is not true. Instead, insurance companies typically cover 50-80% of the treatment fee; the percentage paid depends on the contract between your employer and the insurance company.

 

Fact 2 – Insurance Companies Set Their Own “Allowable” Fees

You probably know that your insurance company reimburses our practice (or you) at a rate that is lower than our fee. They might tell you that our fee surpasses the usual, customary, or responsible fee (UCR) that they determined. This reasoning gives the impression that we are charging excessive fees or are far more expensive than other practices, but this is simply not true.

Every insurance company decides what fees they consider allowable. Allowable fees vary widely, are based on past claims, are randomly determined, and ensure the insurance company makes a net profit of 20-30%.

Regrettably, insurance companies imply that we are “overcharging” rather than stating that they are simply “underpaying” or that their benefits are low.

 

Fact 3 – We Consider Co-Payments and Deductibles When Estimating Benefits

When we estimate your dental benefits, we take into account co-payments, deductibles, and what percentage of the claim we think your insurance company will pay.

For example, suppose the treatment fee is $150. Presuming the insurance company allows $150 as its UCR fee, we can estimate how much the company will pay. First, a $50 deductible will be paid, leaving $100 left. If the plan pays 80% for this particular treatment, they will pay 80% of $100, or $80, which means you’ll have to pay $70. If the UCR is less than $150, or your plan only pays 50%, your benefits will be much lower.

As always, please inform us of any changes to your insurance, such as the policy name, insurance company, address or new employment.