Ole Brook Pediatric Dentistry Office Policies

We schedule appointments for school children who have a lot of work to be done in the morning as well, for the same reason as preschool children. Even though dental appointments are excused during school hours, with regular dental care, missing school can be kept to a minimum.

We understand the need for you to be with your child at all times. However, we prefer that you child accompany our dental staff as that helps us build a closer rapport with your child in your absence.

This is intended solely to gain your child's confidence and to help overcome his/her apprehensions. 

Such behavior is extremely normal and will soon diminish. Studies and experience have shown that most children over the age of three react more positively when permitted to experience the dental visit on their own and in an environment designed for children.

Reach out to us with all your insurance information on the day of your appointment so that we can file your claim for you. You should be acquainted with your insurance benefits, as you will be expected to pay the estimated amount that your insurance will not pay. As per the law, your insurance company is required to pay each claim within 30 days of receipt, and you are responsible for any balance on your account after 30 days, whether insurance has paid or not. We file all insurance claims electronically, so your insurance company will receive each claim within days of the treatment. If you have not paid your balance within 60 days, a re-billing fee of 1.5% will be added to your account each month until paid. Refund will be initiated from our end if your insurance pays us.

Note: We do not have a contract with your insurance company but solely file dental insurance as a courtesy to you. We can neither guarantee what your insurance will or will not do with each claim, nor be held responsible for any errors in filing your insurance. We can only help you in figuring out your portion of the cost of treatment. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim.

Fact 1 - AN INSURANCE PLAN DOESN'T COVER 100% OF ALL YOUR EXPENSES

No dental insurance plan pays 90%-100% of the dental fees. An insurance plan is merely an aid to help you out with your expenses. Most plans pay between 50%-80% of the average total fee. The percentage paid usually varies depending on how much you or your employer has paid for coverage, or on the nature of the contract your employer has set up with the insurance company.

Fact 2 - WE DO NOT DETERMINE THE BENEFITS

If your dental insurer reimburses you or the dentist at a lower rate than the dentist's actual fee, then it is because 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.

Such statements imply 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, which is misleading and far from accurate.

Schedules are independently set by the insurance companies, and each company uses a different set of fees which they consider is right. These allowable fees differ from company to company as 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.

So the insurance companies make your dentist seem like he is "overcharging", rather than say that they are "underpaying", or that their benefits are low. Generally, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

Fact 3 - DEDUCTIBLES & CO-PAYMENTS SHOULD BE TAKEN INTO CONSIDERATION

Deductibles and percentages must be taken into account when you are calculating dental benefits. To elaborate, let us assume the the fee for service is $150.00. Now we can find out what benefits will be paid, by assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee. First a balance of $100.00 is left by subtracting $50 on an average, which is a deductible paid by you. The plan then covers 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, which is to be paid by the patient. Additionally, the insurance benefits will be significantly less, if the UCR is less than $150.00 or your plan pays only at 50%.

MOST IMPORTANTLY, it is requested that you keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.