Office Policy

Your Orange County Pediatric Dental & Orthodontic Office

At Irvine & Capistrano Children’s Dentistry we are committed to providing children in Irvine, San Juan Capistrano, Mission Viejo, Aliso Viejo and the greater Orange County area with the highest quality pediatric dental and orthodontic care. We know the dentist can be a source of anxiety for many kids, so our dedicated doctors and staff work hard to create a fun, warm and welcoming environment for your child. Please read below to learn about our office policies.

How are Appointments Scheduled?

We attempt to schedule appointments at your convenience. We recommend that 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 and missing school can be kept to a minimum with regular dental care.

Since appointed times are reserved exclusively for each patient we ask that you please notify our office 24 hours in advance of your scheduled appointment time if you need to cancel or reschedule. We realize that unexpected things can happen, but we ask for your help in this regard and truly appreciate your cooperation.

Do I Stay with My Child During the Visit?

We invite you to stay with your child during the initial examination. During future appointments, we suggest you allow our staff to accompany your child through the dental experience. We can usually establish a closer rapport with your child when you are not present. Our purpose is to gain your child's trust and overcome any nervousness or anxiety. However, if you choose, you may come with your child to the treatment room. For the safety and privacy of all patients, other children who are not being treated should remain in the reception room with proper adult supervision.

What About Finances?

Payment for professional services is due at the time of your child’s appointment. 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, and most major credit cards.

Our Office Policy Regarding Dental Insurance

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 finance charge of 2% will be added to your account each month until paid as well as a delinquency fee. If there is a credit on your account, we will be glad to send a refund to you once insurance has paid us.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay 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.

Insurance Facts

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. 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 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.

Fact 3 - 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.

Contact Our Irvine or San Juan Capistrano Pediatric Dentistry & Orthodontic Offices

If you have any questions about our office policies, or any of our dental or orthodontic services, please don’t hesitate to contact our Irvine or San Juan Capistrano offices. If you are located in Irvine, San Juan Capistrano, Mission Viejo, Aliso Viejo or the greater Orange County area and would like to schedule an appointment, please let us know. Our staff is happy to help you with any questions or to schedule an appointment for your child. We look forward to hearing from you!

Our Irvine, CA Pediatric Dentists and Orthodontists at Irvine Children's Dentistry are dental professionals dedicated to excellence in pediatric dentistry and orthodontics (braces) for children and teens. Available treatments include dental cleanings, comprehensive exams, digital x-rays, sealants, fluoride treatments, white fillings, crowns, root canal treatments, extractions, emergency care, laser dentistry, gum surgery, cosmetic dentistry, orthodontics, Invisalign, braces and more.

18124 Culver Dr. Suite E
Irvine, CA, 92612
(949) 786-0800
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