How are Appointments Scheduled?
What About Finances?
Policy Regarding Dental Insurance
The office attempts to schedule appointments at your
convenience and when time is available. Preschool children should be seen in
the morning because they are fresher and we can work more slowly with the
child for their comfort. School children with a lot of work to be done
should be seen in the morning for the same reason. Dental appointments are
an excused absence. Missing school can be kept to a minimum when regular
dental care is continued.
Since appointed times are reserved exclusively for
each patient we ask that you please notify our office 24 hours in advance of
your scheduled appointment time if you are unable to keep your appointment.
Another patient who needs our care could be scheduled if we have sufficient
time to notify them. We realize that unexpected things can happen, but we
ask for your assistance in this regard.
What About Finances?
is due at in full at the time of service, for those patients without
insurance. We do not provide payment plans. Dr. Carter is not a
participant in the Medicaid or TX-Care Chips program. We will be glad
to file your insurance if all necessary information is provided.
Dr. Carter is not a "participating
provider" for any insurance carrier. Therefore, most insurance
companies only pay the "reasonable and customary" fees, often
leaving a small balance owed. This is billed to you after
insurance pays us. You will be required to pay your deductible
and percentage owed at time of service.
Our Office Policy
Regarding Dental Insurance
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. You must 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. If you have not paid your balance within 60 days a finance
charge of 1.5% will be added to your account each month until paid.
We will be glad to send a refund to you once insurance has paid us.
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. We are not responsible for how your insurance company
handles its claims or for what benefits they pay on a claim. 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
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)
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
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