Legal Guardian at Dental Visits
Our office policy is that a legal guardian must be present during each dental visit. If a legal guardian is unable to accompany the child, please send a notarized letter with a non-guardian (grandparent, nanny, friend) to the visit.
Insurance and Payment
Our office welcomes all major types of dental insurance. Our front desk staff will be happy to assist you in determining what type of benefits are available to you through your insurance plan. Payment arrangements for account balances are due at the time services are rendered, so please bring your insurance card with you to your visit. Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to others. Your portion of the bill is expected at the time of service. If you do not have dental insurance, payment is due at the time of service. Please understand that payment of your bill is considered a part of your child’s treatment. While we will accept assignment of benefits from your insurance company, you will be responsible for the full balance including any amount that is not paid by your insurance company. Our staff is happy to verify your specific insurance plan information prior to you coming.We accept many forms of payment, including cash and most major credit cards. You can also speak with our front desk about flexible payment options available for major dental services.
DENTAL INSURANCE WE PROVIDE FOR: Metlife, Aetna PPO, Cigna PPO, Delta Dental PPO, Guardian PPO, Empire Blue Cross Blue Shield, United Healthcare PPO, and United Federation of Teachers (UFT).
If you do not see your Insurance Plan here please call us at 646-902-KIDZ(5439). If you have any questions or uncertainty regarding your insurance coverage, please don’t hesitate to call us. We are here to help you.
Dental Insurance FAQ
We are happy to file your insurance claim for you. You should 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 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. PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. There is no direct relationship between our office and your insurance company. The type of plan chosen by you, and/or your employer determines your insurance benefits. As such, we have no say in the selection of your insurance company, no control over the terms of your contract, the methods of reimbursement or the determination of your insurance benefits. We will accept assignment of benefits from your insurance company, however you are responsible for the full balance including any amount that is not paid by your insurance company. We can only assist you in estimating your portion of the cost of treatment, we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.
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 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.
MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.