At Smile Builders Pediatric Dentistry, we ask that you pay for office visits and all treatment at the time of the service. Our dentist and team accept various forms of payment and are in network with many insurance providers. Our team will review your insurance information with you during your child’s first appointment. Please be prepared to pay any amount that is determined not payable by your insurance plan, such as co-pays and deductibles. If you have had any changes to your insurance between appointments, please notify our team before your child’s next appointment.
Our Dentist and Team Accept the Following Forms of Payment:
- Cash
- Check
- Apple Pay
- Visa
- Mastercard
- American Express
- Discover
We also work with CareCredit, a third-party financing group that offers low and no interest payment plans. If you are interested in signing up for CareCredit or would like to learn more, click on the link below.
We Are in Network With the Following Insurance Providers:
- Aetna PPO DHA only
- AlwaysCare PPO DenteMax Plus
- Assurant/Sun Life Financial PPO DHA (Dental Health Alliance Network) only
- Colonial life PPO DenteMax Plus
- Cypress Dental PPO Dentemax Plus
- Direct Dental DHA
- Equitable PPO DHA
- Mutual of Omaha DHA
- Starmount PPO DenteMax Plus
- United Concordia PPO DHA only
- United Healthcare PPO DHA/Sunlife only
- Unum PPO DenteMax Plus
- Humana Dental PPO DHA
Smile Builders Policy Regarding Dental Insurance
As a courtesy, we file all insurance claims the same day as your child’s appointment. By doing this, your insurance company will receive the claim within days of the appointment.
After 30 days, you are responsible for the balance on your account, regardless of whether or not the insurance company has paid. Charges that remain unpaid for 30 days are subject to a late fee. At 60 days after the appointment, the account is sent to our billing agent or attorney. Correspondence will continue with that designated party after that time. You are responsible for all costs of collection, including late fees, court costs and attorney fees.
We file your dental insurance claim as a courtesy to you, our patient. Our office does not have a contract with your insurance company — you do. Dr. Robyn Lesser is not responsible for how your insurance company handles its claims or for what your insurance company pays on a claim. Our team will gladly help you estimate the costs of treatment, but these estimates are not a guarantee of what your insurance provider will do with your claim.
No Insurance Pays 100% of All Procedures
Unfortunately, dental insurance does not cover 100% of your dental procedures. It is a common misconception that all insurance providers pay 90 to 100% of all dental fees, but this is not accurate. In reality, most insurance plans pay between 50-80% of the average fee. Depending on your insurance provider and plan, some will pay more and others will pay less. Much of your coverage is dependent on your employer and how much coverage they have paid for.
Benefits Are Not Determined by Our Dental Office
Insurance companies base their payments on what is considered the usual, customary or reasonable fee (UCR). Each insurance company has a UCR that they have determined is acceptable and this rate varies from company to company. The insurance provider takes data gathered about common dental fees and sets their UCR based on their findings. In some cases, the UCR data is outdated and the fees are set by the insurance company to make a profit.
When a dental office’s fees exceed the UCR determined by your insurance provider, the insurance company will say that the fees are excessive and will only pay a portion of what they deem is acceptable, based on their UCR. Therefore, any benefits not paid out by your insurance company are held responsible by you, the policy holder.
Deductibles & Co-Pays Must Be Considered
In the estimate of dental benefits, we must consider deductibles and percentages, based on fees and your insurance provider’s UCR. For a specific rundown of your insurance provider and what you can expect for fees, our team will gladly work with you to answer all of your questions.
Please keep us informed of any changes to your insurance, including policy name, insurance address or changes of employment.
Be aware of your insurance plan and its benefits. Not all insurance providers are in network with our office. If you are out of network, you may be subject to higher fees, co-pays and deductibles. Some services may not be covered if you are out of network.
It is ultimately your responsibility to know your coverage and benefits, as you are responsible for any payments that are due after your insurance provider has processed your claim.
If our office is out of network, your insurance provider will reimburse us at their UCR fees. Any difference between the UCR fees and the fees of our office are your responsibility. You also are responsible for services not covered by your insurance plan.
If we are in network with your insurance company, our team will adhere to the fee schedule of your provider. Remember that you are responsible for fees not covered by your plan.
Our Office
Do you have additional questions before coming to our pediatric dental office in Dunedin, Florida? Our dentist and team will gladly answer all of your questions when you call 727-285-8184. We look forward to meeting you and caring for your child’s smile.
