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How
are Appointments Scheduled?
Do I Stay with My Child During the
Visit?
What About Finances?
Our Office Policy Regarding Dental
Insurance?
How
are Appointments Scheduled?
The
office attempts to schedule appointments at your convenience and when
time is available. Preschool children should be seen in the
morning because they are fresher and we can work more slowly with the
child 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.
Do
I Stay with My Child During the Visit?
We
ask that you allow your child to accompany our staff through the dental
experience. We are all highly experienced in helping children
overcome anxiety. Separation anxiety is not uncommon in children,
so please try not to be concerned if your child exhibits some negative
behavior. This is normal and will soon diminish. 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.
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What
About Finances?
Payment
for professional services is due at the time dental treatment is
provided. Every effort will be made to provide a treatment plan
which fits your timetable and budget, and gives your child the best
possible care. We accept cash, personal checks, debit cards and
most major credit cards.
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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. 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 30 days, whether insurance has paid or not. If you
have not paid your balance within 60 days a finance charge of 1.5% or
$5, whichever is greater, will
be added to your account each month until paid. We will be glad to send
a refund to you once insurance has paid 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 can not be responsible for any errors in filing your insurance,
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 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 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.
Fact
4 – POSTERIOR RESIN (TOOTH COLORED) RESTORATIONS ARE MAY NOT COVERED
FULLY
Often times insurance companies will reimburse at what they consider
to be the least expensive alternative for a restoration. Most often this
is an amalgam (metal) filling. Posterior resin restorations are more
technique sensitive and more difficult to place; therefore, they
typically cost more money. At our office we believe that the resin
restorations, when done properly, are superior to the old amalgam
restorations that were popular in the past. Amalgam restorations also
contain mercury which according to OSHA guidelines must be treated as a
bio-hazardous material. We at Two Rivers Pediatric Dentistry feel that
we should not place any restoration in your child’s mouth that we
would not place in our own children’s mouths and therefore do not use
amalgam in our office.
MOST
IMPORTANTLY, please keep us informed of any insurance changes such as
policy name, insurance company address, or a change of employment.
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