Since we provide dental care for children, we strive to offer each patient the optimal experience, which includes scheduling appointments around times that are best-suited for the patient’s age. Children under five-years-old usually have a better experience in the morning after a good night’s rest; if it is in the afternoon, young children will generally be exhausted and have little patience for sitting still after already spending hours in preschool or day care. As such, we tend to schedule our young patients for morning visits, and save afternoon procedures for older patients. We also try to schedule longer procedures for the morning, so that the afternoons will be free to older children who need their dental visit after school hours.
Any child under eighteen years of age must be accompanied by a parent or legal guardian for any appointment. If something comes up so that they are unable to attend, they must pre-authorize someone else to go along with the child.
We understand that it can be difficult to keep up with appointments, especially when trying to care for children. Our office will attempt to give you a friendly reminder of your appointment by contacting you via phone, text, or email prior to your scheduled appointment. This reminder will include a confirmation of the day and time of your child’s upcoming visit.
When visiting our offices, we may have paperwork that you will need to fill out; please, arrive at least ten minutes early so that you can take care of this necessary information before the start of your child’s appointment. We understand that some days things come up and it maybe impossible for you to arrive on time; however, if you are fifteen-minutes late for your appointment, you may be asked to reschedule, depending on how booked we are for the day. On days when we have additional openings, we maybe able to work you in for a different appointment after taking into consideration those booked ahead.
Canceled or Missed Appointments
When you schedule an appointment with our offices, you are reserving a time slot that could be used by another patient. As such, we expect you to arrive for all your appointments and to be here on time. To be fair to each patient, we have a standard appointment policy which states the following:
Sometimes emergencies and unexpected events arise and it is impossible to keep an appointment. If you find that you need to cancel or reschedule an appointment, please contact our offices at least twenty-four hours in advance, so that we will have adequate time to offer your appointment time to someone else. If you do give our offices twenty-four hours notice of your cancellation, we may choose to charge your account $50.00
If you miss two appointments without giving our offices a twenty-four hour notice, we reserve the right to opt out of providing your child with future dental care.
Our offices reserve the right to determine who is or is not fined, and who will or will not receive treatment after missed appointments. We determine our course of action based on the individual circumstances surrounding the missed appointment. We realize that, sometimes, emergencies happen and parents are unable to give a twenty-four hour cancellation notice. If you find yourself facing an immediate emergency and are unable to make an appointment, please contact our office as soon as possible so that we can work with you to avoid unnecessary fees or termination of a patient’s care.
It’s not fun making rules; however, we whole-heartedly believe that the above policy helps to make working with our office easier for everyone involved.
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.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
Smile Starters currently participates in some major PPO dental Insurance plans. Coverage and participation can not be guaranteed until insurance is verified. We are happy to discuss coverage prior to your visit and check your benefits.
All other open plan dental insurances are accepted on an out-of-network basis. If you choose to schedule with an out-of-network provider, you are responsible for all fees not covered by your insurance plan.
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. We file all insurance promptly, so your insurance company will receive each claim within days of the treatment. Your insurance processes the claim and sends you notice of the result (estimation of benefits, or “EOB”). Insurance will typically process claims within 30 days. You will be responsible for any deductibles, co-payments, or balances not covered by insurance. You are responsible for any balance on your account after 45 days, whether insurance has paid or not. We will be glad to send a refund to you if your insurance pays us. Although rare, some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.
Insurance is a contract between you, your employer and the insurance company. We are not a party to that contract. We cannot be responsible for keeping up with the ever-changing policies of each individual insurance plan. Depending on your individual plan, all services may not be covered.
Please understand that we file dental claims as a courtesy to our patients. Claims are filed promptly to expedite communication with your insurance company. It is important for you to keep us informed of any insurance changes such as policy name, group and id number, or a change of employment. We are not, however, responsible for how your insurance company processes the claims or for what benefits are ultimately paid on a claim. Our office bases treatment on your child’s needs, not what your insurance will pay. Insurance payments are determined by the benefit package that your employer purchased. We have no way of knowing if, or what, your insurance company will pay until the actual claim is submitted. Therefore, all account balances which have not been paid are the responsibility of the parent/guardian.
PLEASE NOTE: Many plans have frequency limitations pertaining to a number of the procedures done in our office. These limitations may change from benefit year to benefit year. If you are concerned about coverage for these services, please contact your insurance company prior to your visit. We cannot accept responsibility for negotiating a disputed claim and allow a maximum of 45-days for your insurance company to clear account balances. We will assist you in dealing with the insurance company but ultimately the responsibility lies with you. If after 45 days, the insurance company hasn’t paid the balance, payment will be due, in full, by you.
Payment for professional services is due at the time dental treatment is provided:
Payment options include the following:
- Visa, MasterCard, Discover, Amex
- Care Credit
We make every effort to keep down the cost of dental care. If your child’s treatment program requires several visits, you will be given a written treatment plan outlining the proposed treatment for your child and our fees associated with that treatment. Sometimes, it is in the best interest of the child to provide dental treatment before the parents are prepared to pay the full fee at the time of service. Monthly payment plans are available. You may discuss definite financial arrangements with our office business staff. Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to other persons.
For separated or divorced parents: the parent who brings the child to the office is legally responsible for payment of fees charged for that child’s care. If another agrees to payment responsibility, that person must provide a notarized acknowledgment in writing of their desire to pay for care. It is the responsibility of the person bringing the child to the office to obtain a written agreement and to inform the other person of care being provided.
Your understanding and cooperation with this matter is greatly appreciated. You are helping to keep our overhead expenses, in the form of direct and labor costs, down. In addition, you are helping keep your fees as low as possible. If you have any questions please feel free to ask our business office staff.
Please do not hesitate to ask questions about our financial policy. We want you to be comfortable in dealing with these matters. If you have any questions regarding your insurance, we ask that you contact your company regarding the specifics and details of your plan.
- Aetna PPO
- Cigna Dental PPO
- GHI Preferred, Preferred Plus
- Empire PPO
- Delta Dental
- United Concordia
- United Health Care PPO
- Healthplex-MVP, Wellcare, Metroplus
- Americhoice Community plan
- Dental Access
- Dental Save