Office Policies

Kids with wearing safari hat

Changes in the Military Insurance

Beginning 1 May, 2012 the military’s dental insurance will be changing to MetLife; this contract change will mean offices that have been taking United Concordia will have to take up to a 50% cut in fees if they are willing to be “in network” with MetLife. There has never been enough profit at current fees to take a 50% cut so we will not be contracting to be “in network” with MetLife. We’ve been supporters of the military by taking the Tricare insurance for 20 years. We want to still provide dental services for the children of active duty personnel but simply cannot accept a cut in fees; so we are willing to accept the MetLife fees for routine preventive services only. This means we will still see your children for cleanings, x-rays, and exams as if we were “in network” and there will be no out of pocket expense to you. These fees although lower than our normal fees were not drastically cut, and in an ideal situation would be the services your child would need most often. If your child does need additional dental treatment, a discount will be given off our standard fees, but you will have a higher co-pay than if we were in network. And as usual we will always file the dental claim for you as a courtesy. Estimates will be given for all treatment before the treatment is scheduled so there will be no surprises. We are sorry that the Military has chosen to cut benefits to the active duty personnel by changing to an inferior dental insurance program, we expect few if any pediatric dental offices will sign up to be in network providers. We are happy to continue seeing children of active duty personnel and will support you with the above mentioned policies, thank you for your continued support and loyalty.

What Does Out of Network Mean?

Being out of network means we are not contracted with the insurance company as a provider. Most insurance companies will allow you to go out of network and their payment will remain the same. The difference in going out of network is the “in network” providers have agreed to accept the insurance company’s fees instead of their own office fees. For example: If we charge 61.00 for a new patient exam, but the insurance company’s fee list allows $56, and the insurance company will cover 100% of their fee schedule. When we receive the payment back for the exam they will pay $56.00, and in most cases the parents will have to pay the difference. Do not be fooled by the insurance using the terms “usual & customary fees”. Their fees are set arbitrarily and are not what is usual and customary for our zip code. If so why does it fluctuate greatly between companies and with some companies they pay different amounts for different employer plans. Our fees are set to cover our expenses and provide a reasonable profit; two independent surveys show the fees in our office are below average for the area. We strive to keep our fees low and the quality of service high. With our emphasis on preventive dentistry and conservative treatment most people save money even though we are not in network. We do attempt to get information from your insurance company so we can give an informed estimate of what your out of pocket expense will be.

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 them 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.

Do I Stay with My Child During the Visit?

It is important that the parent or legal guardian be with the child for the first visit. If this is not possible, please make arrangements with our office in advance.

At the first visit the child becomes acquainted with the dental office. A thorough examination, which includes a clinical exam and necessary x-rays, will be performed. We welcome the parent in the treatment room except during x-rays in which at that time you may observe from the hallway. Everything will be explained and shown to the parent and child before we do it. A child benefits greatly from the parent who is a silent observer as we develop a positive rapport with the child. When more than one person tries to instruct, the child tends to become confused.>

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.

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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