Regardless of the reason, if the insurance company fails to pay
within 60 days of the date the treatment was performed, the balance
in full is due at that time. After 60 days, a finance charge of 3%
will be added to your account each month until paid.
Dental
insurance is meant to assist patients with payment for regular
dental care. Even if you have insurance coverage, please realize
that you are responsible for payment of your account. We will be
happy to help you receive the maximum benefits available under your
policy; however, the relationship is between you, the insured, and
your insurance company. We are not a party to that contract.
We
attempt to provide the most accurate information available; however,
insurance carriers will not guarantee their information so we regret
that we can not be responsible for any discrepancies in benefits
estimated. Information given to you by our office regarding your
benefits is a courtesy; you should verify and be knowledgeable about
your insurance benefits.
If
insurance is pending, you will receive an interim statement to let
you know that the account has not been paid. A service charge will
not be applied until payment has been received from your insurance
carrier.
If the
recommended treatment involves some type of appliance, half the cost
of the appliance must be paid when impressions are taken. This is
necessary because our office must pay a portion of laboratory costs
when appliances are ordered. The remainder of the cost of the
appliance is due when the appliance is placed.
If
someone brings the patient to our office other than the parent,
arrangements for payments should be planned accordingly.
We
appreciate those patients who honor their scheduled appointments.
We do assess a $25 fee to those patients that cancel without 48
hours of notice, as this time with the doctor has been reserved.
We look
forward to years of close association with you as we work together
to maintain your child’s oral health.
INSURANCE INFORMATION
Facts You
Should Know About Dental Insurance
Dental
insurance plays a role in helping people obtain dental treatment. We
appreciate this fact.
In an effort to help maximize your
insurance assistance, we would like to share some facts about dental
insurance with you.
Fact #1
Dental insurance is not meant to cover all fees; it is meant
to provide assistance for
your investment in your dental health.
Fact #2
Many
carriers announce that they reimburse the insured person “up to 100%
of fees”.
In actuality, we have found many plans cover about 50%
to 60% of average fees. Some plans pay more- some less.
The amount your plan pays is determined by how much your employer
paid for the plan. The less paid for the insurance, the less you
will be reimbursed.
Fact #3
Some insurance companies tell their customers that their dentist’s
“fees are above the usual and customary fees” rather than saying
“Our benefits are low”. Remember, you receive only what your
employer puts into the plan, less the profits of the insurance
company.
Fact #4
Some dental services are not covered by dental insurance.
Fact #5
All
patients are charged similar fees whether or not they have insurance
coverage.
We will
make every effort to help you receive the maximum assistance allowed
under your insurance plan. We cannot, however, change dates
dental care was delivered. We will complete and file our insurance
forms at no charge. In order to provide this service, you must
bring a signed insurance form to the first appointment each year.
Please do
not hesitate to ask questions about our office procedures. We
want you to be comfortable in dealing with these matters, and we
urge you to consult us if you have any questions regarding our
services and/or fees.
If you
have questions regarding your insurance, we ask that you contact
your employer regarding the specifics and details of your plan.
Your dental insurance is between you, your employer and your
carrier. We have no way to affect how much of the fee will be
covered by insurance.
UCR
FEES
What are
UCR Fees and how do they affect you?
What
is a UCR (usual, customary, reasonable) fee?
Insurance companies establish UCR fees. Here’s how they do it:
-
A ‘usual’
fee is the fee that an individual dentist most frequently charges
for a specific dental procedure.
-
A
‘customary’ fee is the fee level determined by the administrator of
a dental benefit plan. This fee establishes the maximum benefit
payable for that procedure.
-
A
‘reasonable’ fee is the fee charged by a dentist for a specific
dental procedure that has been modified by complications or unusual
circumstances. Therefore, it may differ from the dentist’s usual
fee or the benefit administrator’s customary fee.
How are UCR fees determined?
-
UCR fees
are influenced by the fees dentists charge in various geographic
areas and by the population of the area in which a dentist
practices. The Health Insurance Association of America (HIAA)
surveys dentists every six months and helps insurance companies set
UCR fees.
-
Insurance
companies are not legally required to use HIAA’s fee survey or
anyone else’s information when setting UCR benefit levels.
How about UCR fees that don’t cover all costs?
-
UCR rates
may be outdated. It may take up to two years for dentists to return
HIAA’s fee surveys, for HIAA to compile the data, and for member
insurance companies and subscribers to receive it.
-
Geographic differences may not be fairly taken into account when
insurance companies set UCR rates. Insurance companies may split in
half or lump several small communities together to determine one UCR
area.
-
UCR fees
vary widely among insurance carriers. Studies indicate that no two
carriers use the same UCR definition. Customary fee determinations
made by carriers for the same procedure in the same city at the same
time differed by as much as 136%.
What accounts for the difference in dentists’ fees and UCR rates?
In
addition to the limitations of UCR fees, any difference between the
fee charged and the
benefit paid
is due to limitations in the patient’s dental benefits contract.
How are your dental benefits and reimbursement determined?
-
Your
benefits are only as good as the plan your employer has purchased
for you as an employee benefit. The higher the monthly premium, the
better your benefits.
-
The
reimbursement will depend on the cost and type of treatment you’ve
received from your dentist. Dentists are required to submit
information to insurance companies when filing claims, including the
exact treatment provided and the procedures performed.
How does your dentist determine the fee?
-
Dentists
determine fees based on the cost of delivering top quality
treatment, the time involved to provide dental care, and the
overhead cost of to operate a practice.
What
should you do if your dentist’s fees exceed your plans UCR rates?
-
First
keep in mind that dentists base their treatment decisions on patient
needs and not on insurance assistance. Chances are good you have
received the best dental care necessary to maintain optimal oral
health.