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Financial Agreement and Payment Policy
Payment for
professional services is due at the time dental treatment is
provided. Every effort will be made to provide you a treatment
plan which fits your time-table and budget, and gives your child
the best possible care. For your convenience, we accept cash,
personal checks, debit cards, Discover, MasterCard and Visa. Our Policy Regarding Dental Insurance We are happy to assist our families who have dental insurance by accepting their insurance. If we have all of your dental insurance information available on the day of your child’s dental appointment, we will be happy to file the claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. We must be able to confirm with your insurance company that they can assign benefits to our office. If an insurance company cannot confirm assignment of benefits, we ask that you pay for all services when rendered and we will assist you in filing the claim for reimbursement to you. By law your insurance company is required to pay within 30 days of receipt. We file insurance electronically so your insurance company will receive each claim within days of treatment. We have no control over your dental benefits and the amount an insurance company reimburses for a particular service. We do not have a contract with your insurance company, only you do. This means we are not a preferred provider and do not have a contract with any insurance company (we are considered out of network). In some cases, insurance companies will use outdated fee schedules or require a larger co-pay or deductible from the family. We are not told the amount of your co-pay by the insurance company; therefore it is not possible to give you an exact estimate of what is covered. If dental treatment is needed, we will send a pre-estimate to your insurance plan to attempt to get an accurate estimate of benefits. If the pre-estimate has not been received prior to the appointment for treatment, we will require payment of 40% of covered services and full payment of non-covered services. Please understand that you always have the final responsibility for payment of any services rendered. We are not responsible for any limitations in coverage that may be included in your plan. For this reason, we will ask for a credit or debit card number to be kept on file for your account. Your credit card number will be billed for any remaining balance after the insurance payment is received. If your insurance company does not respond within 45 days after the date of service, your credit card will be charged. We do not do statement billing. For our patients with Delta Dental, payment is due in full for all services at the time of the visit. Delta Dental will not confirm they will assign benefit payment to our office. We will, however, offer you the option of filing your insurance claim for you or providing you with the necessary information so you can file the claim yourself.
Thank you
for your assistance and understanding of our financial policy.
Your child’s dental health is of utmost importance to us. By
having this policy, it allows our office to focus our full
attention on your child and his or her dental needs rather than
spending excessive time with financial issues that can limit
those needs. Our staff is always willing and available to
discuss any questions or issues you may have regarding your
insurance plan or the financial policy. Parental Agreement/Office Policies
Parents are
welcome to accompany their child into the treatment area during
the initial examination. This gives you the opportunity to see
our dental team in action and allows the doctors to discuss
dental findings and treatment needs directly with you. We do
ask that if you accompany your child you assume the role of a
silent observer. Your presence is greatly enhanced if you play
a passive role. If more than one person is speaking to the
child they may become confused. Cooperation and trust must be
established directly between the doctors or hygienist and your
child and not through you. We also ask that siblings remain in
the reception room or play area. There may be times when a
child’s experience is enhanced by a parent’s absence. We
encourage children to come back to the treatment area by
themselves as this builds autonomy and trust. After your
child’s first visit your child will come to the treatment area
by themselves, unless specific arrangements have been made in
advance. Children who are very apprehensive may look for an
“escape” by going to their parents – this is why we ask that a
parent wait in the reception room during treatment in order to
facilitate a more direct line of communication between the child
and the doctor. The following is a brief explanation of some of
the methods we use to guide your child’s behavior and provide a
positive dental experience. Since each child is unique, no list
can be complete and other methods may be explained as needed. TELL, SHOW, DOThis is the most important tool for teaching your child. The child is told in simple terms what is going to be done. Then they are shown what is going to be done and then the procedure is performed. IMAGERY
We tell
children in simple terms what is going to be done. For example,
a dental exam becomes “looking and counting your teeth”. A
dental prophylaxis and cleaning becomes “brush and tickle your
teeth”. We encourage you to use these terms when talking to
your child about their dental experiences. DISTRACTION
Sometimes it
is necessary to distract your child from an unpleasant sensation
by focusing his/her thoughts on something other than what is
being done. POSITIVE REINFORCEMENTThis is a technique used to reinforce good behavior by praising your child or providing a reward following a desired response in hopes of promoting continued good behavior. VOICE CONTROLVoice control is a controlled change of voice volume, tone or pace to influence and direct the child’s behavior. This technique is used to establish a line of communication between our doctors and your child.
This agreement
and these policies are in place to ensure that we can provide
the best, most positive dental experience for your child.
Please feel free to ask anyone in the office if you have a
question or questions. Thank you for allowing us the
opportunity to provide dental care for your child. Appointment Scheduling Our office attempts to schedule appointments at your convenience. In order to make your child’s appointment a pleasant and fun experience, we have certain guidelines that we follow. Children under the age of six should be scheduled in the morning because they are fresher and our morning schedule allows us to spend the extra time with them that they deserve. Children age six and over can be scheduled in the afternoon for routine dental and non-invasive dental care, cooperation permitting. If your school age child needs special attention or has exhibited uncooperative behavior at a previous appointment, they should be scheduled in the morning time when we can provide them the extra time they deserve. For all children, we schedule any restorative or invasive procedure in the morning. If your school age child must miss any part of the school day for a dental appointment, we can provide you with a doctor’s excuse. By state law, dental and medical appointments cannot be counted as an unexcused absence if a doctor’s excuse has been provided. Broken Appointments
All of our
appointment times are reserved specifically for each patient and
as a courtesy we will place a confirmation call to you to remind
you of the appointment. For this reason, we ask that you please
notify our office at least 24 hours in advance of your child’s
scheduled appointment time if you are not able to keep the
appointment. This allows us sufficient time to notify another
patient needing our care that an appointment has come
available. If we are not available to speak to directly, we do
have a 24 hour voice messaging system that you can leave a
message regarding changing your appointment. If we are not
given 24 hours advance notice of a cancellation or if the
appointment is missed entirely, we reserve the right to charge a
broken appointment fee. If two or more appointments are missed
or cancelled without sufficient notice, we reserve the right to
inactivate your family as patients in our office. We understand
things happen unexpectedly, but we ask for your assistance in
this regard. |
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Dental Topics Copyright © 2005 Jason Clapp, D.D.S.
and Jessica Bell D.D.S. All Rights
Reserved.
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