Payment Policy and Insurance

A forward from Dr. Johnny:

Having been in the practice and business of Pediatric Dentistry for well over 2 decades, I, like our patients, have on many occasions been frustrated by the confusion created by insurance companies. While I will tell you that dental insurance is extremely less complicated than medical insurance, some common issues exist. The two most common are the percentages of coverage for procedures that they will cover, and secondly procedures for which they will not pay. The explanations below are offered to help our families understand how their own individual insurance coverage may be interpreted.

The most frustrating issue for us as doctors is when insurance carriers deny benefits for a procedure. This is often taken by patients that the procedure is unnecessary. That is where the business side of Pediatric Dentistry and insurance companies collide. What the insurance carrier is really saying is that they’ve made the business decision not to pay for your necessary dental procedure. While I respect their profit needs, our only goal is to provide you with the very best dental care possible. We have always taken this approach. You are our number one priority. We will never allow appropriate dental care to be “dictated” by what insurance companies will or will not pay for.

Our office will always assist you in helping your insurance carrier understand the need for, and to pay for your family’s dental care. Because, after all, you are our family.

God’s Blessings.

Payment Policy

Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which best fits your timetable and budget, and gives your child the best possible care. We accept cash, personal checks, Visa/MasterCard, CareCredit, and ChaseCredit.

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 at time of service. 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 60 days, whether insurance has paid or not. 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 cannot be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.

• NO INSURANCE PAYS 100% OF ALL PROCEDURES
  Dental insurance is meant to be an aid in receiving just 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.
• 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 they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use the lower usual, customary, or reasonable (UCR) figure.

• 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. Assuming that the insurance company allows $150 as its UCR fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100, or $80. Out of a $150 fee they will pay an estimated $80 leaving a portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, going to "out of network" coverage, insurance company address, or a change of employment.