Creating Healthy and Happy Smiles
One Child at a Time

Insurance

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Our Office Policy Regarding Dental Insurance

As a courtesy to you, we will file your insurance claim for you if we have received all your insurance information on the day of the appointment. Please 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 claims within 30 days of receipt. We file insurance electronically so your insurance company will receive the 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 the balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if your insurance pays us.

We are happy to estimate your claim, but this is not a guarantee and you will need to contact your insurance provider to confirm your specific benefits. We also can not be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.

No insurance pays 100% of the costs of all procedures

Dental insurance is meant to help with the costs of dental care. Many patients think that their insurance pays 90 to 100 percent of dental fees. In reality, most pay between 50 to 80 percent of the average fee, depending on which plan you or your employer chose.

Benefits are not determined by our office

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Often your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee and deems the rest to have exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. This label gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or higher than other dentists in the area. This can be very misleading and is simply not accurate.

Insurance companies set their own policies. “Allowable” fees vary widely and can be based on arbitrary or outdated data. The bottom line is they allow the insurance companies to make a net profit of 20 to 30 percent on your coverage.

Unfortunately, insurance companies imply that the dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low. In general, the less expensive the insurance policy, the lower its usual, customary, or reasonable (UCR) figure.

Deductibles and co-pays

When estimating dental benefits, deductibles and covered percentages must be considered. One example:

  • Assume the fee for service is $150
  • Assume the insurance company allows $150 as its usual and customary (UCR) fee
  • A deductible (paid by you), on average $50, is subtracted, leaving $100
  • The insurance plan then pays 80% for this particular procedure, or $80
  • The remaining $20 balance must be paid by the patient

If the UCR is less than $150 or your plan pays at a lower percentage, say 50 percent, 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 know that we will do everything possible to see that you receive the full benefits of your policy.

Other Financial Arrangements

Dental treatment is an excellent investment in a child’s well-being and healthy development. Every effort will be made to provide a treatment plan that fits your timetable and budget while giving your child the best care possible.

Payment for professional services is due at the time it is provided. Dentistry4Children and the office of Dr. Elaine Martinez accepts cash, personal checks, and MasterCard and Visa debit and credit cards. We also offer financing through a separate company, Care Credit Financing.

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