Office Policies
HOW ARE APPOINTMENTS SCHEDULED?
Our office attempts to schedule appointments at your convenience. Children in pre-school and elementary grades are usually seen in the morning. Late afternoon appointments are reserved for middle and high school age patients. Dental appointments are an excused absence, and missing school can be minimal when regular dental care is scheduled. Our office provides school and work excuses when requested.
Since appointed times are reserved for each patient, we ask that you please notify our office at least 24 hours in advance of your scheduled appointment time if you must cancel or reschedule. Another patient who needs our care could be scheduled if we have sufficient time to notify them. We realize unexpected things 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 check-ups and treatment visits. We want every child to feel as relaxed as possible, and having a parent nearby can be comforting. For the safety and privacy of all patients, other children who are not being treated should remain in the reception area with a supervising adult.
NO-SHOW POLICY
This policy has been put into place out of respect for our staff and patients. Exceptions may be made under certain circumstances due to emergency or illness. Please contact our office as soon as possible if you experience an emergency, illness, or other related situation that will affect your scheduled appointment.
If you fail to show for a scheduled appointment without canceling or rescheduling, you will be charged $50 for each occurrence. After two (2) no-show appointments within one (1) calendar year, you will be dismissed from Nix Pediatric Dentistry.
Finances
PRIVATE PAY
Payment is due at each visit for services rendered. We accept cash, Debit Card, Visa, Discover, MasterCard, and Care Credit.
DENTAL INSURANCE
We are happy to submit your claims, and file to all dental insurance companies. Our office is out-of-network with all insurance companies. This means you are responsible for any portion your insurance does not cover. Please be familiar with your insurance benefits, so that you can receive the maximum benefit. You will be billed for the non-covered portion.
PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. 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. Once again, we file claims as a courtesy to you. If your insurance has not paid a claim within 30 days of the date of service, we reserve the right to directly bill the responsible party.
Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think 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 the reimbursement was reduced because your dentist’s fee 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 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 your dentist is “overcharging”, rather than say they are “underpaying” or 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 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%, the insurance benefits will also be significantly less.
MOST IMPORTANTLY, please keep us informed of any insurance changes, such as policy name, insurance company address, or a change of employment.
There are some insurance companies that will only pay YOU as the subscriber. If this is the case with your insurance, we expect you to pay for services in full. We will still file the claim for you as a courtesy, and you can expect a check from the insurance company to be sent to you within a few weeks.
Referrals
Our practice grows through referrals from our patients. We appreciate your recommendation of our office to your friends and neighbors. We thank you for your trust.
