Financials, Payments, Dental Insurance
Green Apple Pediatric and Family Dentistry Office Policies:
- All walk-ins are welcome
- Appointments: 24- hour cancellation notice required ***via phone only***
Payment Plan Options for Dental Services:
- All major credit cards
- Low-interest financing options through CareCredit, ask our team for additional information
Payment for professional services is due at the time dental treatment is provided. We will make every attempt to provide a treatment plan which fits your timetable, budget, and gives your child the best possible care in a prompt manner.
Dental Insurance Office Policy:
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 as a courtesy. However, you must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. Please remember, your treatment plan estimate, is just that, an estimate. We don’t determine your benefits. That is determined by the contract you have with your insurance company. By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. Any balance remaining after 60 days incurs a re-billing fee of 1.5% per month until paid. If your insurance pays, any credit on your account will be reimbursed to you.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to you. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company processes claims, applies benefits, or how it reimburses. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will cover on your dental claim. We cannot be responsible for any errors in filing your insurance as we file claims as a courtesy to you.
We highly recommend you contact your insurance plan to check the status of a claim. Please remember any estimates in your treatment plan are just that, an estimate, and we will not know how much your insurance reimbursement is until your insurance plan processes your claim.
KEY POINT #1- NO DENTAL INSURANCE PLAN PAYS 100% OF EVERY PROCEDURE
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. Since the recent changes to dental insurance coverage in our country, we have noticed that dental insurance coverage has been reduced by almost every dental insurance company. Preventive dental care which used to be covered at 100% is now being covered at a smaller percentage (between 80-90%) plus deductible applied to such preventive codes. Please be familiar with your specific dental plan coverage.
KEY POINT #2- DENTAL INSURANCE 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.
KEY POINT #3- DENTAL PLAN DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages must be taken into account. To illustrate, assume the fee for service is $100.00. Assuming that the insurance company allows $100.00 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 $50.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $50.00, or $40.00. Out of a $100.00 fee they will pay an estimated $40.00 leaving a remaining portion of $60.00 (to be paid by the patient). Of course, if the UCR is less than $100.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.
PLEASE KEEP US INFORMED of any insurance changes such as policy name, insurance company address, or a change of employment. We cannot provide you with accurate treatment plan estimates if we have outdated insurance information on file. It is your responsibility to update this information on your child’s dental record prior to their appointment.
Dental Insurance Information:
- Aetna dental PPO
- Ameritas dental PPO
- Assurant dental PPO
- Blue Cross Blue Shield dental PPO
- Careington dental PPO
- Cigna PPO dental PPO
- Connection Dental dental PPO
- Delta Dental dental PPO
- Guardian dental PPO
- Humana Dental PPO
- MetLife dental PPO
- Principal dental PPO
- United Concordia dental PPO
- United Healthcare dental PPO