Pediatric Dentist
Office Policies for pediatric dentists Drs. Olen Davis and Boo Lee

How are appointments scheduled?
Do I stay with my child during the visit?
What about finances?
Our Office Policy Regarding Dental Insurance

How are appointments scheduled?

The office attempts to schedule appointments at your convenience and when time is available. Preschool children should be seen in the morning because they are fresher and we can work more slowly with them for their comfort. School children with a lot of work to be done should be seen in the morning for the same reason. Dental appointments are an excused absence. Missing school can be kept to a minimum when regular dental care is continued.

Since appointed times are reserved exclusively for each patient we ask that you please notify our office 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. Another patient, who needs our care, could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.

Do I stay with my child during the visit?

We invite you to stay with your child during the initial examination. During future appointments, we suggest you allow your child to accompany our staff through the dental experience. We can usually establish a closer rapport with your child when you are not present. Our purpose is to gain your child's confidence and overcome apprehension. However, if you choose, you are more than welcome to accompany your child to the treatment room. For the safety and privacy of all patients, other children who are not being treated should remain in the reception room with a supervising adult.

What about finances?

Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives your child the best possible care. We accept cash, personal checks, debit cards and most major credit cards. Additionally, we offer easy interest-free payments plans through CareCredit. Please let us know if you would like more information.

Please be aware that the parent and/or guardian who brings the child to our
practice will be responsible for payment of all charges at the time of service.

Our Office Policy Regarding Dental Insurance

We accept cash, check, major credit cards, private dental insurance, Medicaid, and NC Health Choice. Payment for your portion of the treatment that is not covered by your insurance is due at the time of treatment. The parent or guardian that brings the child to the appointment is legally responsible for payment. We do participate with Care Credit as an easy way for our patients to obtain financing for treatment.

Please bring your current insurance card to each visit. As a courtesy to our patients we will accept assignment of benefits from your insurance carrier which means that we will accept payment from your insurance carrier and ask that you only pay your estimated portion at the time of the appointment. You can help us by familiarizing yourself with your insurance coverage since benefits vary among plans. We will assist you in maximizing your full benefits, but please understand that your insurance is a contract between you, your employer and insurance company, not our office and your insurance company.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. There is no direct relationship between our office and your insurance company. The type of plan chosen by you, and/or your employer determines your insurance benefits. As such, we have no say in the selection of your insurance company, no control over the terms of your contract, the method of reimbursement or the determination of your insurance benefits. 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. Thus, you are responsible for payment in full any portion of our fees not covered by your dental plan.

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.

Please note: Delta Dental and Humana plans as well as some federal employee plans will not make payments directly to out-of-network dentists. Families covered by these plans are expected to pay in full for services at the time they are rendered. Our practice as a courtesy will file their dental insurance claims so that they can be reimbursed directly from the insurance company in a timely manner.

Insurance Facts

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.

Fact 4 - INSURANCE & TREATMENTS NOT COVERED
Insurance company may disregard the standards of care that have been recommended by both the ADA and the American Academy of Pediatric Dentistry. We occasionally see dental plans that do not cover recommended procedures such as dental sealants, topical fluoride application and even white "tooth colored" fillings. Insurance plans may also limit the frequencies of these treatments. As a result, only part of your child’s treatment will be covered. You are responsible for the full balance including any amount that is not paid by your insurance company.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

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