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Stephen Fox D.M.D. | Member American Academy of Pediatric Dentistry

Financial & Insurance

While it is impossible to list all the insurance plans our office will submit on your behalf, our insurance coordinator will gladly verify your insurance coverage.


If you have any questions regarding your account, please contact us at 203-886-0028. Many times a simple telephone call will clear any misunderstandings.

If you have dental insurance, check with your company benefits administrator to make sure you have all the necessary information, including employer/employee information and the Group ID# available to give to us.

FEDERAL Blue Cross/Blue Shield members and PATIENTS with NO DENTAL INSURANCE are expected to make full payment for those dental services rendered, the day of the visit to our office unless other arrangements have been made with the business office in advance. We recognize for some, there may be extenuating circumstances, which if brought to our attention, we will work with you on an individual basis.

To keep costs as low as possible and to keep fees reasonable, patients with dental insurance will be expected to pay at the time of your family’s visit to our office, only the unpaid portion of our fee that your insurance plan will not cover. Most plans (not all) will pay us 100% for preventative services every 6 months, regardless of whether the dental provider is “in” or “out” of network. Deductibles may apply and therefore, you will be responsible for these. While we do our best to predetermine what your benefits are, there are times that your insurance company will pay more or less than we anticipated. In such instances, you may receive notice of a “balance due” or a refund check for monies you might have overpaid.

For your convenience we accept VISA & MASTERCARD.

FACTS ABOUT DENTAL INSURANCE:

Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES

Dental insurance is meant to be an aid in receiving dental care. Many parents of patients think that their insurance pays 90%-100% of all dental fees. This is not always true. Most plans 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 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 the “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 figure.

If you receive communication from the insurance company suggesting fees are over and above the usual and customary rate, please be aware it may not take into account factor’s pertaining to our locale, the maximum that your employer has contracted for, and out-of-date fee tables.

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 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 parent/patient). For many of the higher priced premium insurance plans, they will pay 100% of the dentist’s fees for preventative care with no deductibles. Therefore, you would have no co-pays on preventative procedures.

You should be familiar with your insurance benefits. Our office is happy to file insurance as a courtesy to our patients, but you are fully responsible for all fees charged by this office, regardless of your insurance. 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.