Financial Policy

Payment for dental services provided by our office is due at the time treatment is provided. Every effort will be made to provide a treatment plan that fits your timetable and budget and gives you or your child the best possible care. We accept cash, personal checks, debit cards, and credit cards. Our office also accepts payment via CareCredit, a third-party financial institution specializing in healthcare financing. Online applications for credit approval are quick and easy at CareCredit offers multiple longer-term plans, and some include deferred interest. All financial details must be completed prior to the actual procedure being completed.

Insurance Information

At Tosh Dental Group we make every effort to provide you with the finest dental care and the most convenient financial options. We are pleased to file insurance as a courtesy to our patients. As the contractual obligation with the insurance company is between you and your insurance carrier, we do recommend you make yourself familiar with your insurance benefits prior to visiting the office. We will work hand in hand with you to maximize your insurance reimbursement for covered procedures. However, the ultimate responsibility for payment lies with you. If you have any problems or questions, please ask our team. They are well-informed and up-to-date on dental insurance. Please provide your insurance information prior to your initial visit so that we can assist you in receiving your maximum benefit.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. Our office is not responsible for how your insurance company handles claims or for what benefits are paid on a claim. We can only assist you in estimating your portion of the cost of treatment. We at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance. Once again, we file claims as a courtesy to you.

By law, your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically if possible, 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.

Fact 1 – 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 up to a specific annual maximum amount. 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 2 – Benefits are not Determined by our Office

You may have noticed that 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.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.