Your dental insurance policy is an agreement between you
and your insurance company. Please be aware that some, if not all, of
the services provided may be non-covered services and, therefore, are your
responsibility. If your insurance company has not paid your claim within 45
days, the balance will automatically be billed to you. You and not your
'insurance company are responsible for your account. You are expected to pay
your estimated portion at the time of service. Any balance will be billed to
you and payment is expected within 30 days. If your insurance company has
not paid your claim within 30 days, the balance will automatically be billed
to you. In
the event of an account overpayment, we will refund the difference to you.
Accounts
are considered past due after 30 days. Past due accounts will be charged
a Rebilling/ Finance Charge of $5.00 per month. Checks returned by your
bank will be subject to a return check fee. Accounts turned over
to our collection agency or attorney, and sent to court, will be subject
to reasonable attorney's fees and court costs.
Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in obtaining 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 have 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.
Change in CareFirst Participation:
As we announced in April of 2009, as of January 1,
2010 our office will no longer be a participating provider for CareFirst
Blue Cross Blue Shield. You will be responsible for payment in full at
the time of your child’s dental visit. We will, as a courtesy to you,
submit your claim to CareFirst and they will reimburse you for whatever
costs are covered by your particular plan. Please note that your
insurance will NOT cover all expenses. Our office staff will be glad to
assist you in understanding this change in policy. Please feel free to
contact our office manager with any questions you might have. We will,
as always, provide you with the proper dental codes so that you will be
able to contact CareFirst and determine ahead of time, what your
insurance will and will not cover.
MOST IMPORTANTLY, please keep us informed of any
insurance changes such as policy name, insurance company address, or a
change of employment.
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Contact Us

100 Sparks Valley Road,
Suite C
Hunt Valley, Maryland 21152
Phone:
(410) 771-8200
Fax: (410) 771-8201
Email:
TheDentist4Kids@comcast.net