Montclair Pediatric Dentistry

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Patient Resources

How are Appointments Scheduled?

The office attempts to schedule appointments at your convenience and when time is available. Preschool children should be seen in the morning because they are fresher and we can work more slowly with the child for their comfort. School children with a lot of work to be done should be seen in the morning for the same reason. Dental appointments are an excused absence. Missing school can be kept to a minimum when regular dental care is continued.

Since appointment times are reserved exclusively for each patient we ask that you please notify our office 48 hours in advance of your scheduled appointment time if you are unable to keep your appointment. Another patient who needs our care could be scheduled if we have sufficient time to notify them. We realize that unexpected things can happen, but we ask for your assistance in this regard.

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Insurance Welcome!

We collaborate with a variety of PPO dental insurance providers. Navigating the complex landscape of dental insurance plans can be challenging, but we’re here to assist you in optimizing your coverage for eligible dental procedures.

If you require assistance in understanding your dental insurance policy, please don’t hesitate to reach out to us via phone or email, and we’ll gladly provide guidance.

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Insurance Providers

Anthem Blue Cross 100/200/300 and Prudent Buyer PPO
AON Dental Solutions
Blue Shield of CA
Careington 500 Series/Care/Platinum
Cigna DPPO (excluding DPPO Advantage)
Cypress Dental
Delta Dental PPO/Premier (excluding Dentegra/DenteMax)
Metlife PDP Plus/FED VIP (excluding PDP)
UCCI Elite Plus (excluding Tricare/DoD)

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Dental Insurance Policy

Our office is more than happy to file your claim for you as long as you are able to provide us with all of your insurance information. Insurance companies are required by law to pay claims within 30 days of receipt. Because our office files each claim electronically, your insurance will receive the claim within a few days of your office visit.

Regardless of whether insurance has paid your claim, you will be responsible for any unpaid balance after 30 days. After 60 days, your unpaid balance will receive a 1.5% re-billing fee each month it is unpaid. Once your insurance pays us, we will happily send you a refund.

Filing dental insurance for patients is a courtesy service our office provides. It is not our responsibility if there are any errors when your insurance is filed. Because you have a contract with the insurance company, not us, we are not responsible for what benefits you receive or how insurance handles its claims. Our office can only help you estimate what your benefits will be. However, we cannot guarantee that your insurance will pay any amount of money.

We ask that you keep us informed of any insurance changes such as policy changes or change of employment. Having up-to-date insurance information ensures filed claims will reach your insurance provider in a timely manner.

Myth: Insurance will pay for 100% of all procedures

Fact: The purpose of dental insurance is to provide financial aid while receiving dental treatments. Insurance will not cover the total amounts of all dental fees. Rather, many plans only pay around 50 to 80% of the average fee. This is typically decided by either the contract your employer has signed with the insurance provider or how much coverage your employer has paid for.

Myth: Our office determines what benefits you receive

Fact: Some dental insurers reimburse patients at a lower rate than the dentist’s fee. They may say this is because the dentist’s fee exceeds the insurance company’s usual, customary, or reasonable fee (UCR). Statements like this are misleading as they give the impression that a fee greater than what insurance will cover is much higher than what other dentists in the area charge for a similar service.

In reality, insurance companies determine their own schedules and allowable fees. Fees may differ from company to company as they use data from their own claims to determine their allowable UCR fee. Often, this data is about three to five years old. Insurance companies determine their own fees so that they’re able to make a 20 to 30% profit.

An insurance company that says your dentist overcharges for their services likely just has low benefits. A good rule of thumb is insurance companies with a less expensive policy often use a lower UCR fee.

Myth: Deductibles and co-payments have no effect on me

Fact: Deductibles and co-payments need to be considered anytime you’re estimating your dental benefits. Let’s assume your child visited our office, and the service fee is $100. We’re able to determine what benefits will be paid by using the usual and customary (UCR fee).

The average cost of a deductible is $50. Subtracted from $100, that gives us $50 remaining. Let’s say your plan pays 80% for this procedure. That means your insurance company will pay $40 out of $100 bill, leaving you to pay the remaining $60. It all depends on your insurance company. If their UCR is less than $100 or if your plan pays a smaller percentage, the insurance benefits you receive will also be less.

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