Office Policies
Children’s dentistry & Orthodontic Treatment in Newport Beach, CA
At Hersch Pediatric Dentistry & Orthodontics, we strive to help each of our patients achieve a smile they truly feel proud to show off. As a leading pediatric dental and orthodontic practice serving the Newport Beach and greater Orange County, CA area, we proudly offer a range of treatment options including teeth cleanings, sedation dentistry, and kids braces. We work hard to make treatment as convenient as possible for our patients. To ensure we provide the highest quality of care to each of our patients, we’ve instituted a number of office policies that help us carry out our work.
Appointments
We know your time is valuable, which is why we strive to make appointments at our office focused and efficient. As part of that commitment, we reserve your appointment time specifically for you – so if you ever need to change or cancel an appointment, we kindly request 48 hours notice. Unfortunately, if you miss an appointment without giving 48 hours notice, we may charge a $50 per appointment fee for hygiene appointments and a $100 fee for missed restorative appointments.
That said, we understand accidents happen. Sometimes, life just gets in the way! While we can’t “jam” you into the schedule in fairness to our other patients, you’re more than welcome to wait in our office for an opening in the schedule. However, in some cases, it may be easier to simply reschedule your appointment. If you’d like to schedule a visit to our office, simply use our online form to do so:
Financial and Insurance Policies
All other open plan dental insurances are accepted on an out-of-network basis. If you choose to schedule with an out-of-network provider, you are responsible for all fees not covered by your insurance plan.
If we have received all of your insurance information on the day of the appointment, we will be happy to file your 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 file all insurance promptly, so your insurance company will receive each claim within days of the treatment. Your insurance processes the claim and sends you notice of the result (estimation of benefits, or “EOB”). Insurance will typically process claims within 30 days. You will be responsible for any deductibles, co-payments, or balances not covered by insurance. You are responsible for any balance on your account after 45 days, whether insurance has paid or not. We will be glad to send a refund to you if your insurance pays us. Although rare, some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.
Insurance is a contract between you, your employer and the insurance company. We are not a party to that contract. We cannot be responsible for keeping up with the ever-changing policies of each individual insurance plan. Depending on your individual plan, all services may not be covered.
Please understand that we file dental claims as a courtesy to our patients. Claims are filed promptly to expedite communication with your insurance company. It is important for you to keep us informed of any insurance changes such as policy name, group and id number, or a change of employment. We are not, however, responsible for how your insurance company processes the claims or for what benefits are ultimately paid on a claim. Our office bases treatment on your child’s needs, not what your insurance will pay. Insurance payments are determined by the benefit package that your employer purchased. We have no way of knowing if, or what, your insurance company will pay until the actual claim is submitted. Therefore, all account balances which have not been paid are the responsibility of the parent/guardian.
PLEASE NOTE: Many plans have frequency limitations pertaining to a number of the procedures done in our office. These limitations may change from benefit year to benefit year. If you are concerned about coverage for these services, please contact your insurance company prior to your visit. We cannot accept responsibility for negotiating a disputed claim and allow a maximum of 45-days for your insurance company to clear account balances. We will assist you in dealing with the insurance company but ultimately the responsibility lies with you. If after 45 days, the insurance company hasn’t paid the balance, payment will be due, in full, by you.
Payment for professional services is due at the time dental treatment is provided:
Payment options include the following:
- Cash
- Checks
- Visa, MasterCard, Discover, Amex
- Care Credit
Insurance Facts
Fact 1 - Dental Insurance Is A Contract Between You, Your Employer And The Insurance Company
We are not a party to that contract.
Fact 2 - Dental Insurance Is Not Meant To Cover All Fees
It is meant to be an aid to your investment in your child’s dental healthcare. Many routine dental services are not covered by dental insurance.
Fact 3 - No Insurance Pays 100% Of All Procedures
Many patients think that 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 4 - Frequencies & Limitations Of Benefits
The frequency of payment for some procedures may be limited by an insurance company. This is most often encountered in a pediatric dental office with fluoride treatments. The American Dental Association and the American Academy of Pediatric Dentistry recommend the application of fluoride every 6 months since it is proven to be highly effective against tooth decay. Our office follows those recommendations in order to achieve optimal oral health for your child. Therefore, if an insurance plan limits the frequency of the fluoride treatment, the parent will be responsible for this cost. This can also be encountered with other procedures, such as x-rays and sealants.
Fact 5 - 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”) 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.
Fact 6 - 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.
Office Hours
Our office is open to serve you, answer questions, and schedule appointments during the following office hours:
Pediatric Dentistry
Monday, Tuesday and Thursday: 8am – 5pm
Wednesday: 12pm – 5pm
Friday: 8am – 2pm
Orthodontics
Monday: 2pm – 5:00pm
Wednesday: 2pm – 5:00pm
Friday: 8am – 4pm
Contact Your Newport Beach Pediatric Dentist
Above all, our mission is to provide you and your child with the best pediatric dental and orthodontic treatment possible – and if you have any questions about our treatment or want to schedule an appointment with us, we’d love to hear from you. Feel free to reach out to us at our contact page with any questions or to schedule an appointment. We look forward to helping you achieve a beautiful, healthy smile!