Green Apple Pediatric and Family Dentistry Office Policies:
- All our patient visits are by appointment only
- Appointments: 48-hour cancellation notice required ***via phone only***
Payment Plan Options for Dental Services:
- All major credit cards
- Zero to low interest financing options through CareCredit, ask our team about CareCredit.
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 Information:
We help our patients to maximize their benefits with any insurance (including in-network and out-of-network insurances).
Even if we are not in-network with your insurance, we have different options for you! Please call our office to find-out more information. Our phones are open Monday through Thursday from 8:30am to 4:00pm and Fridays from 8:30am to 1:00pm.
Dental Insurance Office Policy:
Call today and ask if we work with your insurance. At Green Apple, we help our clients maximize their benefits while obtaining quality services.
Important note: we encourage our clients to be familiar with their insurance benefits and recognize the following.
- The treatment plans provided at Green Apple are based on estimates only, created using the information provided by insurance companies about their client’s specific plan or contract between the insurance company and our client.
- By law, insurance companies are required to pay each claim within 30 days of receipt. We file claims electronically, so insurance companies receive them within days of treatment.
- Filing claims is a courtesy from Green Apple to our clients. Even though we are not responsible for how insurance companies process claims or reimburse their clients, we can assist in estimating patient portions (cost of treatment).
- Unless a pre-authorization is sent ahead of time, we will not know for sure how much the insurance reimbursement will be until the insurance plan processes the claim.
KEY POINT #1- NO DENTAL INSURANCE PLAN PAYS 100% OF EVERY PROCEDURE
Dental insurance is meant to help patients pay to receive dental care. Many patients think their insurance pays 90%-100% of all dental fees, but this is not true. Most plans only pay between 50%-80% of the average total fee. Depending on the plan, some pay more, and some pay less. The percentage paid is usually determined by money paid for coverage or the type of contract the employer has set up with the insurance company.
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.
This statement gives the impression that any fee above the amount paid by the insurance company, or higher than the amounts charged by other dentists in the area, is unreasonable. This information can be very misleading for patients. Insurance companies set their fee 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 they process. Insurance companies then take this data and arbitrarily choose a level they call “allowable” UCR Fee.
Frequently this data is three to five years old, and the “allowable” fees are set by the insurance company so they can earn a net 20%-30% profit. Unfortunately, insurance companies imply your dentist is overcharging rather than declaring they are underpaying or that their benefits are low. In general, the less expensive the insurance policy, the lower the usual, customary, or reasonable (UCR) figure.
KEY POINT #3- DENTAL PLAN DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, deductibles and percentages are considered. To illustrate this better, let’s assume a service fee is $100.00, and pretend the insurance company allows $100.00 as its usual and customary “UCR” fee. We can estimate the patient portion as follows: First, a deductible is usually paid by the patient, which is on average $50.00, so $50.00 is subtracted from the total amount leaving $50.00 pending. If the insurance plan pays 80% for this particular service, the insurance will pay 80% of $50.00, or $40.00. Out of the $100.00 fee, we can estimate the insurance will pay $40.00, leaving $60.00 to be paid by the patient. Of course, if the UCR is less than $100.00, or if the plan pays at 50% instead of 80%, the insurance benefits will be significantly lower.
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 before their appointment.