We are currently accepting new patients and major PPO plans:
- Aetna
- Anthem
- Carefirst BC/BS
- Cigna PPO, Delta
- GEHA/Connection Dental
- Guardian
- Metlife
- UCC (United Concordia)
- Dental Quest (Commercial/Medicaid).
Payment is due at the time service is rendered. We will make every effort to establish an affordable treatment plan for your child that provides optimal results. Our office accepts cash, personal checks and most major credit cards. Financing is available through CareCredit.
Insurance
If you have another insurance provider, please bring your card to your child’s first visit. If you provide all your insurance information at your child’s appointment, we will submit your claim for your convenience. We will fully attempt to help your child receive full insurance benefits. Please familiarize yourself with your insurance benefits, as we will collect the amount your insurance will not pay on the day of your child’s visit. Once your insurance receives a claim, they are required to pay it within 30 days. Since we file claims electronically, your insurance should receive it within days of treatment.
Please remember, you are responsible for paying any remaining balance on the account after 30 days, whether insurance has paid or not. If you fail to pay the balance on your child’s account within 60 days, a finance charge of 1.5% will be added to the account every month until the balance is paid. We will reimburse you once insurance pays us.
Please understand, we file dental insurance as a courtesy. We are not contracted with your insurance company. Thus, we cannot be held accountable for how your insurance handles claims or what benefits they pay for. We can only assist you by providing an estimate of your portion of the costs for your child’s care. We cannot determine 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.
If you have questions about dental coverage and plan, our team is wiling to assist you.
Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to assist you in paying for your child’s care. Most patients assume their insurance will cover 90-100% of all fees. This is not true! On average, most insurance companies pay 50-80% of the fee. Some companies pay more and some less. The percentage paid depends on the contract between your employer and the insurance company.
Fact 2 – WE DO NOT DETERMINE BENEFITS
You may be aware that your insurance company reimburses our practice or you at a rate that is lower than our actual fee. Insurance companies frequently state that they decreased the reimbursement because our fee exceeds the usual, customary or responsible fee (UCR) utilized by the company.
This statement gives the impression that any fee greater than the amount paid by your insurance company is not reasonable, or far above what the majority of the dental practices in the area charge for a service. This of course can be misleading and is not correct.
Each insurance company sets their own schedule and determines what fees they consider allowable. Thus, allowable fees may differ widely, since each insurance company gathers fee information from each claim it processes. The insurance company takes this information and randomly determines what they consider to be an allowable UCR fee. Often this information is three to five years olds. The insurance company sets these allowable fees so they can make a net profit of 20-30 %.
Regrettably, insurance companies imply that the dental practice is “overcharging” rather than stating that they are simply “underpaying” or that their benefits are low. Generally, a policy that is less expensive utilizes a lower UCR.
FACT 3 – WE MUST CONSIDER CO-PAYMENTS AND DEDUCTIBLES
We must consider your benefits, deductibles and percentages when estimating your dental benefits. For example, suppose the treatment fee is $150. Presuming the insurance company allows $150 as its UCR fee, we can estimate what benefits 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.
Please inform us of any changes to your insurance, such as the policy name, insurance company, address or new employment.