How are Appointments Scheduled?
Do I Stay with My Child During the Visit?
What About Finances?
What are Your Guidelines Regarding Dental Insurance?

How are Appointments Scheduled?

Do I Stay with My Child During the Visit?

In our over 20 years of pediatric dentistry it has been our experience that most children age three and over react best when permitted to experience the dental visit on their own with people specially trained for children and in an environment designed for children as well.  If your child is under the age of three, we will likely ask that you accompany your child through their first visit. However, if your child is three years old or older, we will ask that you allow your child to accompany our team through the dental experience.  We believe in the importance of establishing a fun and loving relationship with both you and your child. A team member will first go through your child's medical history with you prior to taking your child back to ensure that any concerns or specific medical conditions are addressed prior to treatment. Please prepare your child for a fun visit with our team and Freddy the Frog so that they are excited to come back and be a big boy/girl for their dental appointment!
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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 "exceeded the usual, customary, or reasonable fee" ("UCR") used by your insurance 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.

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