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How are Appointments
Scheduled?
What About
Finances?
Our Office Policy Regarding Dental Insurance
How are Appointments
Scheduled?
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 24 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.
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What About Finances?
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.
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Our Office Policy Regarding
Dental Insurance
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.
MOST IMPORTANTLY, please keep us informed of
any insurance changes such as policy name, insurance company
address, or a change of employment.
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The Children's Dental Center ~ Pediatric Dentist,
Merrillville, IN
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