Do I Stay with My Child During the Visit?

This is often one of the first questions parents ask. During new patient exams, we enjoy having parents involved for education. As children begin to trust and gain confidence in themselves and our team, we find it is in the patients' best interest to have the parents out of their child's view.

We ask that you trust our team to accompany your child through his/her dental adventure. Separation anxiety is not uncommon in children, so please try not to be concerned if the child exhibits some excited behavior-you can have confidence that we are very experienced at helping children overcome their anxiety. Studies and experience have shown that most children over the age of 3 react more positively when permitted to experience the dental visit on their own and in an environment designed for children.

Should you choose to accompany your child, we ask that you be a silent observer during the procedure. We have designed the office to be open for you to watch while staying out of your child's view. This allows the doctor and team to develop a personal, confident relationship with your child.

What About Finances?

We are providers for several PPO insurance plans. All deductibles, estimated co-payments, and additional professional services are due at the time dental treatment is provided. Our estimates are made according to the information given to us by the insurance company and the contracted employer. Any additional charges not covered by insurance will be the obligation of the responsible party.

We accept cash, personal checks, as well as VISA, MasterCard, American Express, and Discover credit cards. In addition, we also provide CitiCare Dental Financing by Citibank. Applications are available in the office.

Our Office Policy Regarding Dental Insurance Benefits

If we have received all of your insurance information on the day of the appointment, we will be happy to file the claim for you. You must be familiar with your insurance benefits, because we will collect from you the estimated amount insurance is not expected to pay and any co-pay. By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance claims 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 or not your insurance company has paid a portion of the fee. If you have not paid your balance within 60 days, a finance charge of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you once your insurance company has paid us.

PLEASE UNDERSTAND that we file dental insurance claims 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 company will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance claim. Once again, we file claims as a courtesy to you. If there are questions about insurance coverage, the insurance company will usually respond faster to questions from the policy holder.

Fact 1 - NO INSURANCE COMPANY PAYS 100% OF ALL PROCEDURES

Dental insurance is meant to be an aid to 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% and 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 at a lower rate than the our actual fee. Insurance companies may state that the reimbursement was reduced because our 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 that they consider allowable. These allowable fees may vary widely because each company collects fee information from the 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. These "allowable" fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that we are "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, the less expensive an insurance policy is, the lower its usual, customary, or reasonable (UCR) figure will be.

If your insurance company states that our fee is above the UCR, it does not mean the we are charging more than other doctors in the area. What it means is that we are charging more than the percentile level established by your insurance company's contract with your employer. This percentile can range anywhere from the 70th to the 90th percentile depending upon the particular contract.

Our fees represent the quality care that we provide for each of our patients. We use the very best materials, state of the art technology and highly trained staff to ensure the more positive treatment for your child's adventure.

Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for a 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), is subtracted. Deductibles average $50.00, leaving $100.00 to be charged to the insurance company. Let us now assume that the company pays 80% of UCR for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. This leaves an additional $20.00, for a total of $70.00, to be paid by the policy holder. Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be less.

Please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

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