Patient Forms and Fees

PATIENT REGISTRATION FORMS:

FEES AND DENTAL INSURANCE PLANS:

There are several types of dental insurance plans, which are made possible to employees or members through employers, unions, or associations. These plans vary considerably from one to another.

These insurance plans can be summarized as:

Indemnity Plans: these are the traditional form of dental insurance. You are free to choose your own dentist without penalty by the insurance company. Under these plans, the insurance companies calculate the fees between the 50th and 80th percentile of what they determine to be the usual, customary, and reasonable fees for various services. The insurance companies pay that portion of the fee and you are responsible for the balance of such fees.
PPO's (participating provider plans): these plans require patients to select a dentist from a list of dentists who have entered into an agreement with the insurance companies to accept a pre-set fee. This fee is usually considerably low.
HMO’s and DHMO’s: These are dental health maintenance organizations. Again, under these plans you must choose a participating dentist. The insurance companies provide a set fee schedule which can be substantially lower than the actual cost of the services.
Discount Referral Plans: These plans are offered by some companies or organizations. The referral companies provide patients’ referrals to dentist’s office. In return for these referrals the dentist provides percentage discounts on all procedures to the patient. The referral company does not pay anything to the dentist.
Direct Reimbursement Plans: These are the newest entry in dental cost assistance. The patient pays for his/her treatment and submits the paid receipt to his/her employer for reimbursement. The employer reimburses the employee in whole or in part. These plans are the closest to fee for service which is the procedure followed at the institute for those patients without dental insurance coverage.

The type of treatment you receive at the institute is based upon the doctor's professional judgment, and not on the coverage dictated by an insurance plan. Many factors affect the fees for various services. Our fees reflect the level of expert care, quality, and time necessary to return the patient to a state of optimal function and esthetics.

Additionally, new and advanced technologies are employed at the institute to effectively, conservatively, and most efficiently treat our patients. Our fees reflect such commitment to our patients to restore them to optimal health and esthetics.

We accept most insurance plans. Our competent front office staff will complete and submit your insurance claim form(s), obtain pre-authorization when necessary, and assist you in understanding your financial responsibility. All fees charged for the services we provide that will not be covered by your insurance are due and payable at the time the service is rendered.

Additionally, our office welcomes payment by MasterCard, Visa, and Discover cards. We also offer Capital One Health Care and Chase Health Advance (previously Unicorn) forms for your financing needs. The RDI also participates with Care Credit.

To facilitate your first visit to our office, please complete all necessary registration forms prior to your first appointment. Simply download the forms, complete all entries, and bring them with you.