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Pediatric Dentist and Orthodontist Corpus Christi, Port Aransas, Portland, Alice, TX - Financial Policy

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Financial Policy

Insurance

Dental Insurance

We are a fee-for-service dental office and payment is due in full at time of treatment. As a specialist office, we are out of network with most insurance companies. 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. 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. 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 with filing your claim. We at no time guarantee what your insurance will or will not do with each claim. We also cannot 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.

Payments

We accept cash, checks, debit cards and all major credit cards. Payments are now accepted on our website at www.paulkennedydds.com. Please select the PayPal button on our home page to pay your account online. Payment arrangements may be requested through Springleaf Financial Services at 361-225-3421. We also accept CareCredit. We are happy to assist you with the application process for either company. If payment plan arrangements are needed, please inform our patient coordinator who will discuss those arrangements with you prior to your child receiving treatment.

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Pediatric Dentist and Orthodontist in Corpus Christi, Port Aransas, Portland and Alice, TX