At our office, payment for dental services is due at the time of treatment. We will do our best to create a treatment plan that gives your child the best care possible, while also fitting into your schedule and budget.
We accept cash, checks, debit cards, and most major credit cards. If we have received all of your insurance information prior to your appointment, we will be happy to file your claim for you. However, it is important to be familiar with your insurance benefits, as you will be responsible for paying the estimated amount that insurance is not expected to cover. By law, insurance companies are required to pay claims within 30 days of receipt.
We file all insurance electronically, so your insurance company should receive the claim within a few days of treatment. If your account has a balance after 30 days, you are responsible for paying it, regardless of whether insurance has covered it or not. If the balance is not paid within 60 days, a re-billing fee of 1.5% will be added to your account each month until the balance is paid. If your insurance company does pay us, we will be happy to issue a refund. It’s important to note that we file dental insurance as a courtesy to our patients, and we do not have a contract with your insurance company. We are not responsible for how your insurance company handles its claims or what benefits they choose to pay on a claim. We can only assist you in estimating your portion of the treatment cost.
No insurance pays 100% of all procedures. Dental insurance is meant to aid in receiving dental care, but most plans only pay between 50 and 80% of the average total fee. The percentage paid is usually based on how much you or your employer has paid for coverage or the type of contract your employer has with the insurance company. Additionally, insurance benefits are not determined by our office. Sometimes insurance companies reimburse you or the dentist at a lower rate than the dentist’s actual fee. They may claim that the fee exceeded the usual, customary, or reasonable fee used by the company. However, insurance companies set their own schedules and use different fees they consider to be reasonable. These fees may vary because each company bases them on data collected from the claims they process. The insurance company then selects a level they call the “allowable” usual, customary, or reasonable fee, which is often based on data that is 3-5 years old and is set in order to achieve a 20-30% profit margin.
It’s important to also consider deductibles and co-payments when estimating dental benefits. For example, if the service fee is $150 and the insurance company allows $150 as the usual and customary fee, we can calculate the benefits that will be paid. First, the deductible, which is usually around $50, is subtracted, leaving $100. The plan then pays 80% for this particular procedure, so the insurance company will pay $80, or 80% of $100. This leaves a remaining balance of $70 to be paid by the patient. If the usual and customary fee is less than $150, the insurance company will only pay the amount they consider reasonable and the patient will be responsible for paying the difference.
It’s also worth noting that some procedures may not be covered by insurance at all. In these cases, the patient is responsible for paying the full cost of treatment. If you have any questions about your insurance coverage or payment options, please don’t hesitate to ask.