For your information, our financial policies are here for your review. We are dedicated to providing you the best possible care and service. Understanding of your financial responsibilities is an essential element of your treatment. If you have questions about the policies, please discuss them with our front office team.
Payment is due at the time of service, unless other arrangements have been made with our office. We accept cash, check, Care Credit, MasterCard®, Visa®, Discover®, and American Express®. If you have dental and/or medical insurance, as a courtesy, we will file the claim for you. Keep in mind that your insurance policy is a contract between you and your insurance company.
We also offer Care Credit payment plans as a convenient alternative to consumer credit cards, cash, or checks. Learn more about Care Credit here.
Orthodontic Financial Arrangements
At Pediatric Dental Specialists, we believe that financial considerations should not be an obstacle to obtaining a healthy, beautiful smile. Our treatment coordinator will be happy to discuss fees for orthodontic treatment. In addition, many dental insurance plans now include orthodontic benefits that may help defray the cost of braces. For your convenience, we can also set up your payments so they are automatically charged to your credit card monthly.
Convenient Online Services
With the simple click of a mouse, our secure online service allows you to:
- View your appointment and account information at any time
- Sign up for email or text appointment reminders
- Check your payment history and see current charges
- Print out flex spending reimbursement and tax receipts
If you do not have a patient login, please let us know at your next appointment, and we will gladly help you set up your own personal account.
Insurance
As a courtesy for our patients, if we have received all of your insurance information on the day of the appointment, our staff will attempt to contact your insurance company to obtain your deductible and the benefits available. Based on this information, we will estimate the amount you will owe, above what the insurance will pay. This amount will be due at the day of service.
Please understand that filing your claims is a courtesy our office provides, it does not guarantee payment to us. Insurance carriers do not guarantee estimated benefits. Therefore, we are not assured as to exactly what the insurance will pay until they have processed the claim. For this reason, you will receive a bill from our office for the remaining balance not covered by insurance. Likewise, if the insurance company pays more than the estimated amount, our office will send you a refund check.
Please let us know if you have any questions about your insurance coverage, prior to dental treatment.
Facts About Dental Insurance
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 is simply 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. Updated information will assist us in helping you receive the maximum dental benefits allowed by the insurance company.
