In the world of insurance, it can get confusing for both the patient and provider. Dental insurance can be a helpful tool, but it is important to understand that it may not cover all the services you need or want. Many plans focus on preventive care, like cleanings and exams, while limiting coverage for more complex procedures such as crowns, implants, or cosmetic treatments. Coverage also varies by plan, so it is always a good idea to check with your insurance provider to know what is included. We would be happy to provide you the procedure that is covered by your dental plan. However, if you choose to receive a higher level procedure that is not covered by your plan, we will need to bill you for the difference between your plan benefit and our office fee.

For example, a patient may request a porcelain crown or filling but their dental plan only covers a metal crown or filling. The insurance company will calculate the benefit to you on the Explanation of Benefits (EOB) sheet, based upon a similar procedure covered by the plan, often referred as an “alternate benefit.” However, you received a procedure that was not covered by your dental plan. Therefore, we are allowed to bill you the difference between the benefit calculated on the EOB and our office fee for that procedure.

Understanding Common Examples of Limitations in a Dental Benefit Plan

1. Dental Cleaning (Prophylaxis) - Limitation: Dental cleaning is a benefit only twice per Benefit Period. A third cleaning would not be covered by your plan.
2. Topical Fluoride Applications - Limitation: Topical fluoride is a benefit only for eligible children under age 15 once every 12 consecutive months. Therefore a child over age 15 or under age 15 and receiving a second topical fluoride within 12 months is not covered.
3. Periodontal Maintenance Therapy - Limitation: Periodontal Maintenance Services is available twice per year. A third Periodontal Maintenance Service in the same year would not be covered.
4. Alternate Benefit Services. A "filling" for example, can be an amalgam filling or a composite tooth-colored filing. Each has a separate dental code and price with the tooth-colored filling generally more expensive. Most dental benefit plans do not cover a tooth-colored filling and many patients do not want a silver, or amalgam filling. The same example applies for a steel crown (covered) and tooth-colored crown (not covered).
5. Annual Benefit Cap – Most Dental Benefit Plans have an annual cap or allowance (usually between $1,000 and $1,500 per year. If any dental service is provided and you have exceeded your annual benefit cap, the service is not covered.
6. Waiting Periods - Some plans require a waiting period before a patient's benefits begin to take effect. If you as the patient have not waited long enough for the benefits to begin, the service is not covered. The above examples are only a partial list of limitations and exclusions that appear in dental benefit plans that apply to coverage.

Key Takeaways:

• Your dental benefit is based upon a contract made between YOU, your EMPLOYER, and the INSURANCE COMPANY. We have no control over what insurance can cover or not cover.
• We do our best to have the most up-to-date Explanation of Benefits from your insurance company. However, it is difficult to provide a "guaranteed quote" at the time of service because of the complexities of these plans.
• Be sure to check your dental benefit plan frequently for a complete list of limitations and exclusions.

We are committed to providing you with quality dental care efficiently, so that you may attain optimum oral health in as few visits as possible. We want to respect your time and request the same understanding from our patients. The following is a statement of our Missed Appointment(s), Late Arrival(s), and Cancellation Policy(s), which we require that you read, agree to and sign prior to any treatment.

In order to provide the best services to our patients, we require at least 24 hour notice for cancellations or for rescheduling your appointments. Notices made less than 24 hours significantly limit our ability to make the reserved time available for another patient in need. To ensure we do not miss an attempted cancellation, please call our office and leave a voicemail if there is no response. If leaving a voicemail to reschedule/cancel an appointment before the 24-hour window, you will not be penalized. PLEASE AVOID canceling through text messages.

As a courtesy, to help remind you of your appointment, we make reminder calls, and send multiple text messages days in advance. The cancellation policy still remains in effect if the contact number is not capable of receiving messages. It is highly encouraged to provide a number that can receive text messages. 

No-Show, Last Minute Cancellation/Re-Schedule

We understand emergencies happen therefore we have implemented a 3-Strike system:

• Strike 1: Warning
• Strike 2: Fees
•         $50 for recall appointments      
•         $100 for treatment appointments
• Strike 3: Must pre-pay for all future appointments 
• The fees are not billable to your insurance. 
• The fees must be paid prior to any other appointment being scheduled. 
• If a provider calls in sick, office has a forced shut-down, or any other instance that is not of the patients err that requires a re-scheduling then it will not count against the patient. 

Late Arrival

If you are 10 or more minutes late for your appointment, the appointment may be canceled and/or rescheduled per the provider's discretion. If the appointment needs to be canceled/rescheduled, this will count as a strike. Please be cognizant of your commute time and plan accordingly. We reserve specific time for an appointment to be completed within our standard of care. Rushing through an appointment or running behind time causing other patients after you to be delayed is unacceptable, and below our standard of care. 

Policy Statement

At Chung Family Dental, we are committed to providing quality care to all patients. However, there are certain situations that may warrant the dismissal of a patient. This policy serves to clarify these circumstances and the procedures involved.

Reasons for Dismissal

Patients may be dismissed from our practice for the following reasons, including but not limited to:

1. Non-Compliance: Failure to follow treatment recommendations or instructions provided by the dental team, leading to poor prognosis of oral conditions and further complications.
2. Frequent No-Shows or Cancellations: Missing scheduled appointments without prior notice or consistently canceling appointments without a 24 hour notice, which disrupts the schedule and affects other patients. See No-show, Late Arrival, Cancellation Policy Form for more details.
3. Inappropriate Behavior: Aggressive, threatening, or disrespectful behavior towards staff or other patients.
4. Failure to Provide Accurate Information: Providing false or misleading information regarding medical history, insurance, or personal details.
5. Unmet Financial Obligations: Ongoing failure to settle outstanding balances or make agreed-upon payments.

Procedure for Dismissal

1. Review: The decision to dismiss a patient will be reviewed by the dental team to ensure it aligns with the reasons outlined above.
2. Notification: The patient will receive a formal dismissal letter detailing the reasons for the dismissal, effective date, and any necessary instructions regarding their care.
3. Transition of Care: The practice will provide assistance in transferring medical records to a new dental provider upon request. The practice will cease on-going treatment and provide only emergency dental care until the patient has established a new dental provider for 90 days.
4. Final Appointments: In some cases, a final appointment may be scheduled to discuss the dismissal and provide recommendations for future care.

Appeal Process

Patients who wish to appeal their dismissal may submit a written request for reconsideration to the practice within 30 days. The dental team will review the request and respond accordingly. See the Dismissal Appeal Form on our website.

Conclusion

We strive to maintain a positive and respectful environment for all patients and staff. Our dismissal policy is designed to uphold this standard while ensuring that all patients receive the care they deserve and to protect our staff.