How are appointments scheduled?
The office attempts to schedule appointments at your convenience and when time is available. Younger children should be seen in the morning because they are fresher and we can work more slowly with them for their comfort. School children with a lot of work to be done should be seen in the morning for the same reason. Dental appointments are an excused absence. Missing school can be kept to a minimum when regular dental care is continued.
Since appointed times are reserved exclusively for each patient we ask that you please notify our office 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. Another patient, who needs our care, could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.
Smile Builders Policy Regarding Dental Insurance
We ask that you pay for office visits and treatment at the time the service is rendered. We accept cash, check, as well as Visa, Mastercard, American Express, and Discover, for your convenience. We also accept Care Credit, which offers no interest payment plans with no annual fees (subject to credit approval).
We will review your insurance information with you at the time of your first appointment. You will need to be prepared to pay any amount that is determined not payable by your insurance plan, such as co-pays, deductibles and/or percentages. Please notify the office of any changes to your insurance at the time of appointment.
We file all insurance the same day as your appointment 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 insurance has paid or not. All charges that remain unpaid for 30 days or more are subject to a late fee. At 60 days, all accounts are turned over to our billing agent and/or our attorney, and correspondence with resume with them. You are responsible for all costs of collection, including late fees, court costs, and reasonable attorneys’ fees.
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, and we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance, as once again, we file claims as a courtesy to you.
Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in 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%-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 SMILE BUILDERS PEDIATRIC DENTISTRY
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 say that they are "underpaying", or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.
Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. 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), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
Please be aware that there are many new insurance plans and policies. New plans through the Insurance Marketplace Exchange and newer commercial plans may have many changes. It is very likely your policy may have restrictions you may not be aware of. Your plan may restrict you to a different network of dentists, apply a higher copay or deductible, or some services may not be covered at all.
Remember: It is ultimately the patient/family’s responsibility to know their coverage and benefits. You will be responsible for any balance due after your insurance plan processes your claim. **To find out what your insurance plan covers and what your financial obligation may be, call the customer service number or member services department of your insurance company. We are happy to provide dental codes for procedures you are checking on.
If we are out-of-network with your plan, your insurance company will reimburse us at their determined “Usual Customary and Reasonable” (UCR) fees as described above. You will be responsible for any differences that result between the UCR fees and the dentist’s fees. In addition, you are responsible for any services not covered by your plan.
If we are in-network with your plan, then our dentists have a contract with your insurance company, and the dentist will adhere to their fee schedule. However, you are responsible for any services not covered by your plan.
If you have any questions regarding insurance, please contact a member of our front office team to assist you.
We are IN-NETWORK for the following plans:
- Delta Dental PPO
- Delta Dental Premier
- Assurant/Sun Life PPO DHA (Dental Health Alliance Network) only
- Aetna PPO DHA only
- United Concordia PPO DHA only
- Cigna PPO
- Cigna PPO Advantage/Baycare Advantage
ANY OTHER INSURANCE PLAN:
If we are out of network with your plan, please make sure your plan allows you to see an out of network provider. In this case, the insurance company will reimburse at UCR (Usual, Customary, Reasonable) fees which may or may not reflect the fees of our office. We will file your claim for you, however you will be responsible for any differences in these fees, if any.
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