Dental Insurance and Payment Options
Financing Your Care
Once the recommended procedures are understood and accepted, the estimated fees will be discussed. Although we try to be as accurate as possible in our treatment estimates, changes may occur as care progresses. This can result in a difference in the actual cost for treatment. We will be happy to assist parents covered by insurance in the preparation of their forms. Please remember that any insurance matters are the responsibility of the insured party. Parents will be personally responsible for any financial obligations incurred whether or not their insurance company agrees to cover the services rendered. It is important to remember that some recommended procedures might not be covered by your insurance plan. Rest assured, we will only recommend dental treatment that can be of real benefit to your child. We do not believe that insurance companies should determine what might be best for your child. For those wishing accurate insurance information, prior to authorization forms can be prepared.
The cheapest cavity to fix is the one you never get! Proper diet, hygiene, and routine preventive care are the best ways to save money at the dentist.
Payment is due in full at each visit. If using insurance, please read the section on this page that explains some of the more confusing aspects of insurance policies. PLEASE REVIEW YOUR INSURANCE COVERAGE PRIOR TO YOUR VISIT WITH US. Your policy is a contract between you and your insurance company. Understand your benefits to reduce any surprises.
We accept Cash, Checks, Visa, Mastercard, American Express, Discover, Care Credit, and Debit Cards for payment.
Please provide us with your insurance information when scheduling your child’s appointment and have your filled-out “Insurance Policy Form” with the other completed forms at your child’s first visit.
If you have a PPO dental benefits package, we can send a “pre-determination of benefits” to assist you in understanding what services will be covered if you request it prior to an upcoming appointment. After services have been completed, we will submit your claim electronically after each visit for reimbursement. Please keep in mind, annual maximums, deductibles and covered services vary widely among policies, even within the same insurance company. It is not uncommon for routine pediatric dental treatment to be excluded from the benefits plan.
Please remember that our doctors make their recommendations for treatment and checkup schedule based on what is best for your child, NOT according to the insurance coverage. At times your child’s needs may be beyond the scope of what your insurance is contracted to pay. If you have questions as to why a given recommendation is being made, please talk to your child’s dentist.
We do not participate with any EPO or HMO plans at this time. If you have an EPO or HMO plan, you will be responsible for the full cost of treatment.
If you have questions about your benefits package we cannot answer, please contact your employer’s benefits coordinator or your insurance company directly.
Why You Might Experience Higher than Expected Out of Pocket Expenses
There any many reasons why parents experience higher than expected out of pocket expenses when using their PPO Benefits Plan. These could include:
(1) No dental insurance pays 100% of all procedures. Percentages of coverage, annual maximums, deductibles, covered services and age limitations are negotiated between the insurance company and your employer. Because of strict limitations set by the insurance companies patients may have higher than expected out of pocket expenses.
(2) Annual maximums vary widely even within the same insurance company. Even a modest treatment plan can exceed the annual maximum benefit which can result in higher than expected out of pocket expenses.
(3) Your insurance company may define and limit coverage of procedures by a patient’s chronological age rather than dental age. When these ages do not coincide patients may have is higher than expected out of pocket expenses.
(4) For a variety of reasons it may be recommended that you child have periodic oral evaluations at 3, 4 or 6 month intervals. Your benefits plan will not necessarily reimburse for all of these exams, cleanings and x-rays, which may result in higher than expected out of pocket expenses.
(5) Insurance companies have developed “UCR fee schedules” that can vary widely. They are not a related to the average fee schedules for dental offices in Sonoma County or the fee schedule of the Children’s Dental Health Center. This can result in higher than expected out-of-pocket expense to the patient.
We are here to help! Please call for more information about financing your oral health needs in our office!