New Dental Patient Information – Arlington Heights, IL

•Fact 1– No dental insurance pays 100% of all procedures, insurance is meant to be an aid to offset some of the cost of receiving dental care. Many consumers think that their dental insurance pays 100% of all dental fees but this is not the case and most plans pay between 50% to 80% of the average total fee less your per patient deductibles (usually $50-150/yr). Some pay less, very few pay more. The coverage amount is determined by your insurance co.’s fee schedule which is determined by the plan that has been negotiated between the employer and the insurance company. The simple rule is lower cost insurance plans pay less in benefits and cover fewer procedures.

•Fact 2– You may notice that your insurance covers a lower rate than the dentist’s actual fee. Frequently, insurance companies state that their payment was reduced because your dentist’s fee exceeded the UCR fee (usual, customary and reasonable) used by the insurance company. This gives the impression that any fee higher than their “allowed fee” is unusual, not customary and unreasonable for a procedure. This wording is misleading and inaccurate. Insurers set their own “allowed fee” schedules and they are very slow to increase them for things like inflation, wage and dental material price increases. Many insurers have gone years without ever increasing their allowed fees because this is what their claim payouts are tied to, yet they quickly increase the premiums you pay them citing things like inflation, wage and materials price increases, etc. As a result, the insurance company has very low “payout” amounts based on stale, outdated info but the premiums you pay them have been regularly increased. Their wording implies that your dentist’s fees are unreasonable rather than disclosing that their “allowed fees” for claim payments are outdated and far below the current market rates for dental procedures.

•Fact 3 – Embedded Dental Policy and High Deductible policies are very costly to you; Buyer Beware!!! If your dental policy is embedded within your medical policy or you’ve chosen a high-deductible policy you will most likely have to pay significant out of pocket amounts ($2000, $3000, $5,000 or more) just to meet your medical deductible BEFORE your dental coverage benefits kick in. These plans trick you with a low monthly premium payment but wind up being extremely expensive when dental treatment is needed. As the insurance holder, you are responsible for knowing if you have a high deductible or dental embedded policy, not our office.

If you have PPO dental insurance and benefits have been verified, we will file the insurance claims on your behalf and accept assignment of benefits meaning we request the insurer send the claim payment to our office. (Delta Dental and BCBS Federal Employee Plans refuse our assignment request with most claims because we are not in their networks and send payment to the policyholder). The parent/responsible pays the patient portion that insurance will not cover, including deductibles, at the time of treatment.

While we do our best to estimate the expected amount your insurance will cover, we do not know exactly what your insurance will pay so we collect the estimated amount. We do not know how much your insurance will cover because our office is out of network and dental insurers do not share their out of network reimbursement fee schedules with out of network dentists. Therefore, we will file your claim with your PPO insurance and await payment and you are responsible for any balance that might remain after the dental insurance has paid our submitted claims.

- The parent/guardian/family member bringing the child to the appt is responsible for paying the patient portion at time of treatment and must bring a form of ID and a method of payment with them to the appointment.

- Our office can not call spouses, ex-spouses, family members or any other 3rd party to obtain payment at time of treatment. Parents/responsible parties can call ahead and provide a form of payment to our front desk if you will not be with the patient at the appointment.

- We accept cash, check, MasterCard, Visa and Discover credit cards but not AmEx.

- For patients without insurance we recommend exploring payment options with CareCredit.com and other medical financing options and applying for the credit on their website before scheduling any treatment.

- Please be advised that the policy of this office is to charge $50.00 for a missed appointment unless canceled by contacting our office or replying "cancel" to the text reminder at least 48 hours prior to the appointment as we have other patients on waiting lists and require adequate lead time to schedule them into any earlier times that may become available.

- For appointments on Saturdays and holidays when kids have no school, our missed appointment fee is $100.00 as our doctors and staff value their Saturdays and holidays highly as well.

- Accounts with balances more than 90 days past due will be assessed late fees. Unpaid balances that are 120 days or more past due will be assessed a late fee and then be submitted to a 3rd party medical collections service and collection fees up to 15% of the unpaid balance can be assessed and all reporting credit bureaus will be notified. - Once submitted for collections the patient records are inactivated and are no longer a patient of the practice.