Since we care for children, it is not possible to give everyone appointments in the late afternoon. We like to reserve these times for older children. Children under age five are in a better frame of mind and have a more positive experience in the morning. The best time for appointments is not after school when your child is tired of sitting and needs to be physically active. Younger children need rest at this time of the day. We prefer to see children requiring long appointment procedures in the morning. In this way, we can be fair to our many patients who require shorter procedures by offering them more available times in the afternoons when the school day is over. A Parent or Legal Guardian must be present with all minors, under 18 years of age, for all appointments. If a parent/ legal guardian is not available to accompany their child, prior authorization is required.
We will attempt to contact you by phone prior to your scheduled appointment. This is to confirm with you the day and time reserved for your child.
Please arrive at least 10 minutes prior to your appointment time to fill out any necessary paperwork and update your child’s medical history. If you arrive more than 15 minutes late to your appointment, you may be asked to reschedule. Contingent upon the day’s schedule you may be able to be worked in. If you agree to do so you must wait until an appointment time is available or another patient cancels. We thank you in advance for your understanding and cooperation.
Operative and Routine Treatment Appointment Policy
Valuable time has been reserved for your child’s restorative or hygiene dental appointment. A missed appointment results in lost time, which could be offered to another patient in need of treatment if the proper cancellation notice is given. We make every effort to stay on schedule so we respectfully ask patients to be prompt and keep their appointments. Our standard appointment policy is as follows:
If you must cancel your child’s appointment, please call our office at least 24 hours in advance. A 24 hour notice is required to cancel or change an appointment. A $50.00 fee may be charged to your account if the appointment is missed, cancelled or rescheduled without 24 hour notice.
Broken or Missed Appointments: If two (2) broken/missed appointments occur or two (2) cancellations without 24-hour notice, our office reserves the right to not schedule subsequent appointments.
Exceptions to this policy can be determined only on an individual basis, according to the circumstances. We understand that occasionally, children’s illness or other unexpected emergencies make it necessary to cancel an appointment with less than 24 hour notice. Please contact our office immediately and we will do our best to accommodate your situation.
We assure you that following all of the above policies will allow us to serve you and your child better.
All other open plan dental insurances are accepted on an out-of-network basis. If you choose to schedule with an out-of-network provider, you are responsible for all fees not covered by your insurance plan.
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. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. We file all insurance promptly, so your insurance company will receive each claim within days of the treatment. Your insurance processes the claim and sends you notice of the result (estimation of benefits, or “EOB”). Insurance will typically process claims within 30 days. You will be responsible for any deductibles, co-payments, or balances not covered by insurance. You are responsible for any balance on your account after 45 days, whether insurance has paid or not. We will be glad to send a refund to you if your insurance pays us. Although rare, some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.
Insurance is a contract between you, your employer and the insurance company. We are not a party to that contract. We cannot be responsible for keeping up with the ever-changing policies of each individual insurance plan. Depending on your individual plan, all services may not be covered.
Please understand that we file dental claims as a courtesy to our patients. Claims are filed promptly to expedite communication with your insurance company. It is important for you to keep us informed of any insurance changes such as policy name, group and id number, or a change of employment. We are not, however, responsible for how your insurance company processes the claims or for what benefits are ultimately paid on a claim. Our office bases treatment on your child’s needs, not what your insurance will pay. Insurance payments are determined by the benefit package that your employer purchased. We have no way of knowing if, or what, your insurance company will pay until the actual claim is submitted. Therefore, all account balances which have not been paid are the responsibility of the parent/guardian.
PLEASE NOTE: Many plans have frequency limitations pertaining to a number of the procedures done in our office. These limitations may change from benefit year to benefit year. If you are concerned about coverage for these services, please contact your insurance company prior to your visit. We cannot accept responsibility for negotiating a disputed claim and allow a maximum of 45-days for your insurance company to clear account balances. We will assist you in dealing with the insurance company but ultimately the responsibility lies with you. If after 45 days, the insurance company hasn’t paid the balance, payment will be due, in full, by you.
Payment for professional services is due at the time dental treatment is provided:
Payment options include the following:
- Visa, MasterCard, Discover, Amex
- Care Credit
Orange County Pediatric Dentistry will make every effort to keep down the cost of dental care. We believe everyone should be able to have a bright and healthy smile.
We make every effort to keep down the cost of dental care. If your child’s treatment program requires several visits, you will be given a written treatment plan outlining the proposed treatment for your child and our fees associated with that treatment. Sometimes, it is in the best interest of the child to provide dental treatment before the parents are prepared to pay the full fee at the time of service. Monthly payment plans are available. You may discuss definite financial arrangements with our office business staff. Please be aware that the parent bringing the child to our office is legally responsible for payment of all charges. We cannot send statements to other persons.
For separated or divorced parents: the parent who brings the child to the office is legally responsible for payment of fees charged for that child’s care. If another agrees to payment responsibility, that person must provide a notarized acknowledgment in writing of their desire to pay for care. It is the responsibility of the person bringing the child to the office to obtain a written agreement and to inform the other person of care being provided.
Your understanding and cooperation with this matter is greatly appreciated. You are helping to keep our overhead expenses, in the form of direct and labor costs, down. In addition, you are helping keep your fees as low as possible. If you have any questions please feel free to ask our business office staff.
Please do not hesitate to ask questions about our financial policy. We want you to be comfortable in dealing with these matters. If you have any questions regarding your insurance, we ask that you contact your company regarding the specifics and details of your plan.
FACT 1 – DENTAL INSURANCE IS A CONTRACT BETWEEN YOU, YOUR EMPLOYER AND THE INSURANCE COMPANY. We are not a party to that contract.
FACT 2 – DENTAL INSURANCE IS NOT MEANT TO COVER ALL FEES. It is meant to be an aid to your investment in your child’s dental healthcare. Many routine dental services are not covered by dental insurance.
FACT 3 – NO INSURANCE PAYS 100% OF ALL PROCEDURES. 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 4 – FREQUENCIES & LIMITATIONS OF BENEFITS. The frequency of payment for some procedures may be limited by an insurance company. This is most often encountered in a pediatric dental office with fluoride treatments. The American Dental Association and the American Academy of Pediatric Dentistry recommend the application of fluoride every 6 months since it is proven to be highly effective against tooth decay. Our office follows those recommendations in order to achieve optimal oral health for your child. Therefore, if an insurance plan limits the frequency of the fluoride treatment, the parent will be responsible for this cost. This can also be encountered with other procedures, such as x-rays and sealants.
FACT 5 – 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”) 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 6 – 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.