Insurance
what you need to know
ABOUT INSURANCE
Here at Sweet Tooth, we do everything we can to help make your family’s trip to the dentist one that is a great experience. We do this partly by making it easy to pay for services.
Payment for services is due at the time dental treatment is provided. Every effort will be made to provide explanations of treatment plans and to provide one that fits your timetable and budget. Our primary goal is to provide your child the best possible care. We accept cash, credit or debit card at the time of treatment. We do accept most major commercial PPO dental insurances. In addition, we have in house membership plans and also can arrange special third party payment plans for certain treatment plans. Please ask us about these options.
We need to have your insurance information on the day of the appointment in order to file your insurance claim. Please be familiar with your insurance benefits as we will ask for payment from you of the estimated amount your insurance is not expected to pay. We can only assist you in estimating your portion of the cost of treatment and cannot guarantee what your insurance will or will not cover with each claim. Please help us help you! We do our best to help you with as much information as possible.
FACT #1: NO INSURANCE COMPANY 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.
Our Happy Patients
“The team is the best of the best! The practice is spotless, the team is caring and organized, and Dr. Arroyo truly puts her patients above all else. If there’s anywhere that you can trust that your family is in good hands, it’s at Sweet Tooth Pediatric Dentistry!!“
– Gabrielle C.
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