Financial Policy and Insurance
We appreciate your promptness in arriving for your child's dental visit. We reserve a specific time for your child according to their dental needs and level of cooperation. Please be aware that after school appointments are limited and in high demand. It may be necessary for your child to miss school for their dental appointment. Dental appointments are excused absences from school, and we will gladly provide a school excuse for your child. Parents with children under the age of 18 must remain on the premises during their child’s treatment time.
We value your time and we do our best to remain on schedule throughout the day. We do ask that you please remember that each child in our office is an individual and some may require more patience and "TLC" than others. We make every effort to stay on schedule, however children are frequently subject to accidents. In order to accommodate an injured child, our schedule may be delayed. Please accept our apologies ahead of time should such a delay occur during your child’s appointment. Understand we will do exactly the same if your child is ever in need of emergency care.
It is the policy of our office to confirm appointments. We utilize a confirmation system that will send you emails and/text messages to confirm your child’s appointment. We ask that you follow the instructions instructing you how to reply to the email or text message to confirm the appointment. Since appointed times are reserved exclusively for each patient we ask that you please notify our office at least 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. It would be a shame if another patient, who may need our immediate care and attention, could not be scheduled because we did not have sufficient time to notify them of a potentially open appointment slot. We realize that unexpected things can happen, but we ask for your assistance in this regard. We do reserve the right to charge a $50.00 fee for broken appointments.
In the event of a dental emergency, please call our office immediately. The first 30 minutes are critical. One of our doctors is available at all times. If you call after hours, our answering machine will give the number to reach the doctor on call.
If a permanent tooth is knocked out, rinse it off. Do not scrub it. Gently place it back into the socket. If it will not go back into the socket, put it in milk. Call our office and arrange to be seen by the doctor immediately. We will rearrange our schedule to see an injured child. Because many of the accidents children have involve the mouth, we frequently see emergencies. We make every attempt to remain on schedule, but emergencies occasionally cause delays. If this happens during your child's appointment, please remember we will also be available if your child is ever injured.
Financial Policy and Insurance
Payment for professional services is due at the time dental treatment is provided. Our office accepts cash, personal checks, debit cards, VISA, Discover or MasterCard and Care Credit. A $20 overdraft will be charged to your account for each returned insufficient check. We now accept CareCredit.
Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to other people.
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. We accept most PPO insurance plans and are an in-network provider with United Concordia (we do not participate with all United Concordia plans, please check on their web site to be sure your insurance plan is one that we participate with.), Met Life, Blue Cross Dental and UPMC Advantage. As a service to our patients, we will bill insurance companies for services as long as they will send payment directly to our office. Any portion not covered by your insurance due to co-pays, deductibles, etc. will be billed to you. If your account becomes 120 days past due it may be turned over to our collection agency. You will be responsible for all cost of the collection.
If we determine that your child needs treatment during their examination, we will give you an estimate for the recommended dental work. If you have dental insurance for your child, we can send in a pre-determination to your insurance company so you will know what portion, if any, you will be required to pay at the time of service. Our office bases treatment on your child’s dental needs, not what your insurance will pay.
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. It is your responsibility to be aware of your insurance company and your benefits. 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.
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. Assuming that the insurance company allows $150 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. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100, or $80. Out of a $150 fee they will pay an estimated $80 leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 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.