downloadable formS & POLICIES
We have provided a way for you to complete basic registration forms prior to arriving for your first visit. To avoid delay, you can download these forms. Simply click on the links below and a new window will open up with a PDF document.
To print the above forms you will need Adobe Reader. Get Adobe Reader here if you do not have it..
Payment plan
We’re pleased to offer a third party payment option to our patients - CareCredit, North America’s leader in patient payment plans. CareCredit lets you begin your treatment immediately – then pay for it over time with low monthly payments that fit easily into your monthly budget. CareCredit is the credit card exclusively for healthcare services. With no up-front costs and no pre-payment penalties, CareCredit lets you pay over time and frees up cash and credit cards for the other things you want or need. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatments.
Apply online for your CareCredit card today!
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OUR OFFICE POLICY REGARDING DENTAL INSURANCE
We will file your claim for you if we have received all of your insurance information on the day of your appointment. You must be familiar with your insurance benefits, as we will collect from you the estimated amount your insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. We will be glad to send a refund to you if your insurance pays us.
PLEASE NOTE THE FOLLOWING:
Distinctive Dentistry files claims as a patient courtesy. 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. We do not have a contract with your insurance company.
NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees, which is not true. Most plans only pay between 50%-80% of the average total fee. 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.
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 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.
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 us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
