FACTS
YOU SHOULD KNOW ABOUT DENTAL INSURANCE
Dental insurance is not meant to be
a pay-all ... it is only meant to be an aid.
Many plans tell you that you will be
covered "up to 80-100%". In spite of what you have
been told, we've found most plans cover only 15-50%
of an average fee. The amount your plan pays is determined
by how much your employer pays for the plan. The
less he paid for the insurance, the less you will
receive.
It has been the experience of many
dentists that some insurance companies tell their
customers that "fees are above the usual and customary" rather
than admitting that their benefits are low.
Many routine dental services are not
covered by dental insurance at all.
If you have any questions regarding
your insurance, you should contact your company regarding
the details of the plan it is conducting in your
behalf. We are happy to help you submit your claims,
and we will try to get the maximum benefit for you
that your plan provides.
IT IS THE PATIENT/SUBSCRIBER'S
RESPONSIBILITY TO KNOW THEIR INSURANCE PLAN AND ITS
COVERAGE.
We participate with the following
insurance companies:
- Delta
- MetLife
- Guardian
- Aetna PPO
As a courtesy, we will complete and
file insurance forms for many other companies.
Payment Policy
Payment is expected at the time of
service. However, on laboratory procedures, half
of the patient portion is due at the start and the
balance is due at insertion. (i.e. crowns, bridges,
removable partials and dentures, inlays, onlays,
implants, appliances, etc.)
If needed, we have applications for
Care Credit, a company that, upon
approval, will finance your dental account into an
affordable payment plan.
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Sample Services
Consent Form: |
Consent for Services
If You Do Not Understand this Section Please Ask.
A CHARGE WILL BE MADE FOR BROKEN APPOINTMENTS UNLESS 48 HOURS NOTICE HAS BEEN GIVEN. As a condition of your treatment by this office, financial arrangements must be made in advance. The practice depends on reimbursement from the guest for cost incurred in their care and financial responsibility on the part of each guest must be determined before treatment. A Dental Finance Company is available for payment arrangements. All emergency services or any dental services performed without previous financial arrangements must be paid for in cash at the time services are performed. If applicable, estimated insurance co-payments will be calculated and due at the time of services, in accordance with state and federal laws. This office will help prepare the guest's insurance forms or assist in making collections from insurance companies and will credit any such collections to the guest's account. However, this dental office cannot render services on the assumption that our charges will be paid by an insurance company.
Guests who carry dental insurance understand
all dental services furnished are charged directly
to the guest and that he or she is personally
responsible for payment of all dental services.
Guests that have dental insurance must understand
that insurance is a method of payment assistance,
not a method of treatment and that dental benefits
are based upon a contract made between employer
and insurance company directly. Estimated insurance
co-payments are calculated prior to reservations
and in accordance with state and federal laws,
due at the time of services.
I understand that the fee estimate list for the dental care can only be extended for a period of 90 days from the date of the patient examination.
In consideration for the professional service
rendered to me, or at my request, by the Doctor,
I agree to pay therefore the value of said services
to said Doctor, or his assignee, at the time
services are rendered.
I grant my permission to you or your assignee to telephone me at home or at my work to discuss matters related to this form. I have read the above conditions of the treatment and permit the doctor to treat me. I certify that I have read and understand the above. I acknowledge that my questions, if any, about inquires set forth above have been answered to my satisfaction. I will not hold my dentist, or any other member of his/her staff responsible for any action that they take because of errors or omissions that I may have made in the completion of this form. |
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