INSURANCES

Our Office Policy Regarding Dental Insurance

“Don’t be fooled.” The difference between Kiddsmiles and most other pediatric specialists is that we are “in network” with most insurance plans (a list of all plans Kiddsmiles participates with is provided here).


The meaning of an “in network” provider is that Kiddsmiles is contracted with your insurance plan to only charge the fee’s that have been agreed upon by Kiddsmiles and your insurance carrier. The only charges you will be responsible for is your deductible and your copays, which have been determined by your insurance carrier and/or employer, as well as any services that your insurance carrier may not cover. However, when going to an “out of network” or “non-participating” provider you will be paying the providers own office fees, which is not regulated by your insurance carrier and in most cases substantially higher than the regulated fees.


Many other Pediatric dentists will tell you they will accept your insurance towards payment. Don’t be misled. This simply means they will take what your insurance company pays to an “out of network” provider, but you will still be responsible for their regular fees.


By understanding how your insurance works makes your experience to your child’s dental visit easier. You do not need to fill out any paperwork nor do you need to spend any unnecessary lengthy phone calls with your insurance carrier. Our highly trained insurance staff takes care of all of that for you.


Kiddsmiles always sends a pre-approval for any dental treatment that your child may need to have prior to the treatment. When your insurance carrier receives the pre-approval, they send it back to Kiddsmiles stating what your “co-pay” is for every procedure which helps us keep your “out of pocket” expense to a minimum. Please also be aware that no insurance carrier will ever give a 100% guaranteed for payment until the services have been completed and the insurance carrier receives the claim. This is not Kiddsmiles’ policy; it is your insurance carrier’s policy.


If you have any questions regarding your plan at any time during your visits our receptionists and insurance coordinators are more than happy to explain your individual plan to you.


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. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days a re-billing fee of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you if your insurance pays us.


Payment for professional services is due at the time dental treatment is provided. Every effort will be made to provide a treatment plan which fits your timetable and budget, and gives your child the best possible care. We accept cash, personal checks, debit cards and most major credit cards.


 

Insurance Information

Here at Kiddsmiles we know how important it is to have a great healthy smile. To better help you we now participate with many new plans, some are listed below. If you should have any questions, please call and speak with our kid friendly staff.
AETNA PPO DENTAQUEST - FIDELIS, HEALTHFIRST, HAMASPIK, AFFINITY, METROPLUS HEALTHPLEX PPO (HOLBROOK, PORT JEFFERSON STATION, AND WHITE PLAINS ONLY) SOLSTICE
AETNA DIRECT ACCESS (DISCOUNT PLAN) EMPIRE COMPLETE/PRIME JJ STANIS SUNLIFE
ANTHEM BC/BS EMPIRE FEE FOR SERVICE LINCOLN FINANCIAL UMR
ASSURANT DENTAL INSURANCE EMPIRE PREMIUM MERITAIN UNITED HEALTHCARE COMMUNITY PLAN
CIGNA PPO FIRST AMERITAS METLIFE PPO UNITED HALTHCARE PPO
CIGNA HMO GEHA MUTUAL OF OMAHA UNITED HEALTHCARE EHB
CIGNA DIRECT ACCESS (DISCOUNT PLAN) GHI PREFERRED PREMERA UNITED CONCORDIA FEE FOR SERVICE
CSEA GHI PREFFERED PLUS PRINCIPAL UNITED CONCORDIA TRICARE
DANIEL H. COOK MANHASSET EDUCATION ASSOCIATION GHI PREFFERED PREMIER PHYSICIANS MUTUAL DENTAL UNUM
DHA GUARDIAN PPO SIDS METRODENT PLUS
DELTA PPO & PREMIER HUMANA SIDS METRODENT PREMIER
WHITE PLAINS: Healthplex Pro D.D.S (White Plains and Port Jefferson) MVP

Discount Plans


North East Dental(NDP) -25% off our office fees


Eastern Dental Plan(EDP) -25% off our office fees


Dental Save -25% off our office fees


Hip Careington -20% off our office fees


Aetna Direct Access


Cigna Direct Access

SEE WHY KIDDSMILES IS PERFECT FOR YOU AND YOUR FAMILY!

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. 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.

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.

Talk to an expert

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.

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