USUAL AND CUSTOMARY FEES
Insurance companies would like you to believe that usual and customary fees are the “average fees charged by dentists throughout your local area” for each respective procedure, when in fact nothing could be farther from the truth. Usual and customary fees vary from insurance plan to insurance plan and depend solely on the plan purchased by you or your employer. Even within the same insurance company, various types and levels of dental plans are offered, some of which are higher value plans with more procedures included in the plan and others of lower value with fewer procedures covered in the plan. The usual and customary fees represented in each plan are based on the value of the plan. This insures that a pre-determined level of profit will be made by the insurance company regardless of the plan or the procedure.
PRE-AUTHORIZATIONS AND PRE-DETERMINATIONS
Our office does not provide either pre-authorizations or pre-determinations for proposed treatment, either verbally or in writing. Pre-authorizations or pre-determinations are not required by insurance companies and are not a guarantee of payment by an insurance company. According to the insurance companies, they are intended to give you an idea of what might be covered for a particular procedure if (1) the plan is in effect at the time when service is rendered, (2) benefits have not previously been expended and (3) the procedure provided is a covered benefit. None of that will actually be determined until a formal claim has been submitted. Further, a claim cannot be submitted until treatment has been rendered. For that reason, the insurance company will never guarantee benefits based on a pre-authorization or pre-determination. If you want to obtain a pre-determination, you must do that on your own by phoning the insurance company. We will provide you with the proper dental billing codes and associated fees for your intended treatment. We will not speculate or advise you on how much an insurance company may or may not pay on a particular procedure even though we may contact your insurance company to confirm active coverage.
ACCOUNT STATEMENTS AND DELINQUENT ACCOUNTS
A statement of your account will be mailed to you each month if an outstanding balance exists. You will receive a statement even though a claim has been submitted to your insurance company and payment from the insurance company has not yet been received.
On all overdue accounts, collection activity will proceed as follows:
No. Days Overdue Action
45 - Balance due in full.
60 - Second reminder letter by mail
90 - Account is sent to a collection agency or small claims court
In all situations, the count of days overdue will begin on the date when the claim is submitted, usually on the day when treatment is started.
If an account is referred to small claims court and a judgment is rendered in our favor, in addition to your overdue balance, you will also be responsible for the payment of all court costs and attorney fees associated with obtaining such a judgment. A minimum charge of $75.00 will be added to your account if it is referred to small claims court. If, due to unknown circumstances, you are unable to pay your account in a timely manner prior to collection activity commencing, please contact our office to make arrangements for payment. If you have any questions regarding your account at any time, please feel free to contact the receptionist during normal office hours.
NSF CHECKS AND CHECKS DRAWN ON CLOSED BANK ACCOUNTS
If a check is returned unpaid to our office from your bank due to non-sufficient funds, we will apply a $15.00 NSF charge to your account and contact you either by telephone, text or email and advise you as such. At your request, we will resubmit the check one time only and if it is returned unpaid a second time, an additional $25.00 NSF charge will be added to your account. At your option, you can personally pick up the NSF check from our receptionist upon payment of the balance due. If you instruct us not to resubmit the check and you fail to clear the balance due within 5 working days of when the check was first returned, an additional $25.00 NSF charge will be added to your account at that time.
If a check is returned unpaid to our office from your bank due to a closed account, a $25.00 NSF charge will automatically be added to your account. We will contact you either by telephone, text or email and advise you as to the returned check,