We participate in many major dental insurance plans. We accept assignment of benefits toward payment of your total fee. We will work with you to insure that you receive the greatest benefit from your dental plan.

We are preferred providers for Delta Dental, United Concordia and APA Partners.

The best dental service is based on friendly, mutual understanding between the dental office and patient (parent). Therefore, we invite you to discuss any questions regarding your dental care and/or dental insurance.

  1. If you have insurance that will cover the charges for dental treatment in this office, you will need to bring the insurance cards or insurance forms with you on the first visit. If your insurance should change, you must inform us with the appropriate cards or forms.
  1. If we have agreed to accept the assignment of benefits, we will gladly file the claim for you and assist with any follow up.
  1. You must expect to pay the non-covered percentage of the cost of treatment at each visit. We will estimate what your portion will be based on information we have available to us. Please remember that it would be impossible for our business staff to know every insurance plan. We literally deal with thousands of plans in this office. Our estimates are close, but you may end up owing an additional balance based on plan deductibles, yearly maximums, termination of employment, a change of dental plan by your employer, etc. ANY BALANCE NOT PAID BY THE INSURANCE COMPANY IS SOLELY YOUR RESPONSIBILTY.
  1. If your insurance company has not paid your claim in a reasonable amount of time, we will ask you to pay for the services in full and work out reimbursement with your insurance company.

If you feel uncomfortable with any of the above information, or if we feel that there is not a mutual understanding of our insurance arrangements, we will ask you to pay in full at the time of service and file your own insurance.

Our obligations to you:

  1. We will always treat you with a friendly, professional manner.
  2. We will file your claims and try to assist with any follow up.
  3. We will gladly answer any treatment or insurance questions.
  4. We will always try, with the best of our ability to estimate your insurance coverage.

Your obligations to us:

  1. To understand that you, and not the insurance company are financially repressible to our office for the services rendered.
  2. To educate yourself/spouse on YOUR dental coverage. When making decisions to have dental care for your child, you must know what coverage is available to you to help you pay for these services.
  3. If you have any questions, please ask.
  4. If you feel uncomfortable with our insurance policies, please pay in full at the time of the service and have your insurance company reimburse you. This will help alleviate any misunderstandings.

The goal of this dental office is to provide the best dental care for your children and to make yours and your child’s visit as enjoyable as possible. By reading and understanding the above information, we hope we can have a mutual understanding of dental insurance. If you have any questions, please do not hesitate to contact us by calling 785- 3911.

Insurance Facts

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, and 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 your 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 dentist 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 processed. 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 saying 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 and 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 usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible (aid by you), $50 on average, is subtracted, leaving $100 left to be paid. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of the $100, or $80. In all, out of a $150 fee, they will pay an estimated $80, leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays only 50%, then the insurance benefits will also be significantly less and you will pay more.
  

Insurance Information