Dental Insurance & Financial Information

What About Finances?

Dental Work Lilburn, GAPayment for our dental services and dental procedures is due at the time the dental treatment is provided. Every effort will be made to provide a specific dental treatment plan which fits your timetable as well as your budget, and gives you the best possible pediatric dental care in Lilburn, GA. Our children's dental office accepts cash, personal checks, debit cards and most major credit cards. In addition, we also offer financing options through Care Credit and Citi Health.

Our Dental Office Policy Regarding Dental Insurance

If we have received all of your insurance information on the day of your child's appointment, we will be happy to file your dental claim for you. You must be familiar with your dental insurance benefits, as we will collect from you the estimated amount your dental insurance is not expected to pay for your child's dental treatments. By law, your dental insurance company is required to pay each claim within 30 days of receipt. We file all dental insurance electronically, so your dental insurance company will receive each claim within days of the dental treatment.

We try to get accurate information about dental insurance benefits and coverage before the dental treatment, but we cannot be sure what the insurance company will pay, if anything, until the claim is submitted and the insurance company actually pays on the claim itself. It is not unusual for dental insurance companies to give us erroneous information about coverage or their given benefits.

This is important because you are responsible for any balance on your account after 30 days of nonpayment from the dental insurance company. If you have not paid your balance within 30 days, a re-billing fee of 1.5% will be added to your account each month until it's been paid. We will be glad to send a refund to you if your dental insurance pays us eventually.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients at our pediatric dental office in Lilburn, GA. 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. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.

Fact 1 – NO INSURANCE PAYS 100% OF ALL DENTAL SERVICES AND DENTAL PROCEDURES

Dental insurance is meant to be an aid in receiving dental services and dental procedures. Many patients think that their dental 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 dental coverage, or the type of contract your employer has set up with the insurance company.

Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR DENTAL OFFICE IN LILBURN, GA

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.

MOST IMPORTANTLY

Please keep our pediatric dental office in Lilburn, GA informed of any dental insurance changes such as:

  • Policy name
  • Insurance company address
  • Change of employment

Gainesville

Click Here To Visit Our Gainesville Family Site

770-628-0678
3535 Thompson Bridge Road
Gainesville, GA  30506

Hours:
Mon - Fri: 8:00am - 5:00pm
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Lilburn

Click Here To Visit Our Lilburn Family Site

678-606-9416
609 Beaver Ruin Road NW,
Suite B
Lilburn, GA  30047

Hours:
Mon - Fri: 8:00am - 5:00pm
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