Our office will provide your insurance company with all the information necessary to help you receive your maximum benefit. We ask parents to know your insurance coverage and the benefit limits of your particular policy. Please keep your insurance information up to date with our office.
There is not any direct relationship between our office and your insurance company. Your insurance benefits are determined by the type of plan chosen by you and/or your employer. As a result, we have no control over the terms of your insurance, the methods of reimbursement, or the determination of your insurance benefits, including how often a procedure is covered. We will file your insurance, accept the assignment of benefits, and help estimate what your insurance will pay. You will be responsible for any portion of services NOT covered by your dental insurance at the time services are rendered. These fees include deductibles, co‐pay, or certain procedures not covered by your insurance company. We accept cash, personal check, MasterCard, VISA, American Express and Discover. Please bring a copy of your current card, so we can provide you with accurate pricing for each visit. If you have any questions, we’re here to help! Just give us a call at 919.267.4211.
IF INSURANCE DOESN’T COVER IT, MY KIDS DON’T NEED IT, RIGHT?
No way! While insurance is great because it helps to pay for dental services, those policies are designed in the best interests of the company, not your child. Insurance adjusters should not dictate what treatment needs are appropriate for your child- only a licensed pediatric dentist who considers all the information can present those choices to parents. Our goal is to help you get the best care and services necessary for your children.
Our focus will be on providing your child with everything they need, and nothing they don’t. Families who “only want treatment if insurance covers it” may find that our practice may not be a good fit for them. However for those parents who want a provider who
Most plans routinely pay between 50‐90% of the average total fee for a covered procedure. This percentage is determined by how much your employer has paid for coverage. Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges.
If you are new to our office, and you would like to verify coverage with your insurance company, the typical services (with dental codes) we perform on the first visit include:
0150 – Comprehensive Oral Evaluation
0272 – Two Bitewing Radiographs
1120 – Cleaning
1208 – Fluoride Varnish
We will recommend cleanings and fluoride every 6 months or as needed, for each child’s specific situation.
In-house insurance plan
Don’t have a dental insurance plan for your child? Give us a call. Our “in-house” insurance plan includes cleanings, xrays, exams, and a significant discount off most services, so that your child can get back to having a healthy and happy mouth, all at a very affordable price. As always, we offer payment plans and easy ways to get your child’s treatment completed, through our relationship with CareCredit. Call 919.267.4211 for more details or apply for CareCredit now.
Your co-pay or your portion of the payment is expected at the time of service. Our office is unable to schedule subsequent appointments if there is a balance on the family account. With certain insurance plans, pre-payment prior to initiation of services may be necessary. We will do our best to inform you if this applies to your particular insurance plan. Any balance that is not covered by your insurance is the responsibility of the parent/guardian. Accounts that are past due over 30 days will be sent to small claims court for collection, and are subject to additional fees which will be added to the delinquent balance. Please help us avoid this step by paying your bill promptly.
We hate surprises as much as you do!
In order for you to be able to make the best choices for you and your family, we want you to have a clear understanding of the proposed treatment, as well as why the treatment is necessary. We make all efforts to provide parents and guardians with the most accurate breakdowns of recommended treatments and your financial responsibilities associated with them, prior to your child’s appointment.
Your estimated payment amount is due the day of service.
For our families with Dental Benefits, we would like to remind you that you have a contract with your insurance company. These contracts have their own unique terms and conditions. We will do our best to contact your insurance company before your appointment to get the most accurate breakdown of the benefits you should receive. Please note: our office is only able to obtain the information given to us by your insurance company, which can include information that is truncated, incorrect, and/or misleading. However, when an insurance company fails to follow through with their obligations, The Smiling Turtle will work with you to contact them and attempt to resolve the issue.
Your insurance should pay their portion – not you!
Most dental benefit plans do not pay for the entire cost of your dental care. Some plans may include a deductible and/or patient co-payment for each visit and procedure performed. Our policy is to collect your deductible and/or co-payment the day of the appointment. We will do our best to assist you in maximizing your dental benefits. However, as dental benefits are a contract between you and your insurance company, we cannot guarantee how much, or if, they will pay for services rendered. In instances of non-insurance payment, the balance due on the account must be paid, in full, by the parent or guardian.
High House Pediatric Dentistry is an in-network and preferred provider for all major dental insurance plans. Not sure if we accept your plan? Give us a call! Many smaller insurance carriers participate under “umbrella” programs, of which we accept many.
We accept cash, checks, all major credit cards, and CareCredit.
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.