Financials & Insurance
We love what we do and never want finances to be an impediment to your family receiving the best dental care. We are proud to offer in-house financing for all orthodontic patients and pediatric dental treatment plans. This allows our treatments to be interest-free and not impact your credit rating.
At Oceans Orthodontics and Pediatric Dentistry we understand how important insurance benefits are to you. That’s why we participate as In Network in so many insurance plans. This ensures you maximize the benefits of your plan. By having your child’s dentist and orthodontist working together, we can also ensure that there will never be confusion or misappropriation of dental or orthodontic benefits between the multiple offices some people have to visit.
Oceans Care Plan
In an effort to help control the increasing cost of dental care, Oceans Orthodontics & Pediatric Dentistry has created a discount plan for families without dental insurance. This is not an insurance policy, but a plan entitling the recipient to significant discounts off our offices’ customary fee.
How do I obtain coverage? It’s easy. Simply complete a short agreement, pay your annual fee in full and your child is immediately covered. If the application process is completed at your child’s initial dental visit, we’ll even allow you to begin using benefits for that visit.
Are there any requirements? The only requirement is that your child cannot be covered by an existing dental insurance. This plan is exclusively for those that have no other dental insurance coverage.
How and when is this policy renewed? Once your child’s policy is activated, you will be given an anniversary date. This date is very important, as it is when you will need to renew your child’s plan each year.
- Dental Cleaning
- Doctor Exam
- Fluoride Treatment
- X-Rays as Necessary
- Orthodontic Discount
- Discount on treatment
- No deductibles
- No enrollment forms
- No annual individual or family maximum allowed benefits
- No claims to fill out for reimbursement
- No downgraded benefits
- No pre-approvals
- No denial of payment for prior treatment
- No waiting periods
- Columbia Dental Plans
- Dental Health Alliance / Sunlife
- Delta Dental
- Horizon Blue Cross Blue Shield
- United Concordia
Important 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.