Pediatric Dental Insurance & Payment Policies
By design, our pediatric dentists are not in network with any insurance companies and parents make all payments directly to us for our pediatric dental services. Payment for services rendered is due at the time of the appointment. This means we do not accept assignments and we do not take payment from any insurance company. Our administrative team will then electronically file your dental insurance claim on your behalf at no extra charge and the dental insurance company will directly reimburse parents.
Anytime that payment in full is a true family hardship, we will gladly set up a monthly payment plan and work with you.
We recognize that the best way to maintain full control over the quality of pediatric dental services is for our doctors to remain independent from what insurance companies dictate. Insurance companies do not always have your children’s best interests at heart.
Our pediatric dental team is what is referred to as a “fee for service” practice. Parents will generally find that the difference between our fees and what your insurance company pays will not be significant. There is a pervasive myth pushed by insurance companies to the contrary. They do this not because they have the best interest of your children in mind, but rather because they wish to further expand their corporate power and profit.
Believe it or not, sometimes what the insurance company would allow us to charge for a procedure might actually be higher than what we charge. In that case, we would never take advantage of that and charge you more. When your insurance company will not reimburse you our entire fee, you will find that the difference you are responsible for, in the long run, is not significant.
A trend in dentistry is for families to move from one dental home to another based on dental insurance coverage changes that occur with the company/employer parents work for. We believe that this is one of the worst consequences to have come out of the expansion of dental insurance. Families moving from place to place destroys the continuity of care, relationship building, and the ability for a doctor to truly know your children as they grow and develop.
Remaining independent allows every family to stay in our practice and we firmly believe that it is important for children to have a consistent dental home while they are growing up. This is a strong predictor of whether or not they will adopt good oral health routines and seek routine dental checkups in adulthood.
Insurance Myths
Myth #1
Insurance companies work with dental offices to determine what benefits your child should truly have and what the actual true cost is for the pediatric dentist to provide the treatment necessary to care for patients. This is not the case at all.
What actually happens is that insurance companies set their own fee “schedules,” and each insurer uses a different set of fees that they will allow for various types of dental treatment. Those fees are referred to as “allowable” fees. The amount of money the insurance company has decided should be charged for a procedure is known as the UCR fee (usual, customary, or reasonable), and it varies widely across thousands of plans and companies.
When an insurance company reimburses you less than the dentist’s actual fee, and the explanation provided is that the fee charged is higher than the UCR, this implies that the dentist has charged an unusually high fee that is not customary and is unreasonable. Giving the impression that your dentist is overcharging when the insurance company has built in a 20-30% profit margin for themselves is not only inaccurate, it is misleading and unethical.
Myth #2
My insurance will pay 100% of all procedures if my dentist is in network with my insurance. When asked, most people believe that dental insurance pays 85%-100% of all your dental fees.
The reality, in general, is very different and, on average, ranges from 50% to 80%. Dental insurance rates are negotiated between your employer and the insurance company and there are literally thousands of network plans available. Our goal is to focus on being experts in taking care of you and your children. The more time we spend on insurance, the less time we have for your child.