Frequently Asked Questions
We are happy to assist in filing insurance on your behalf to Metlife, Delta Dental, Cigna, Medcost, Ameritas, Aetna and more! Call us office for more information!
We are not considered “in-network” with any dental insurance companies. For our patients with dental insurance, you will be asked to provide accurate and complete insurance information, as we are happy to file your insurance benefits for you.
Any estimated copay is payable at the time of treatment. If we do not receive payment from your insurance company within 30 days, you will be expected to pay for all dental services completed.
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As a courtesy, we will file your primary dental insurance claim for you provided that we have received all of your insurance information on the day of the appointment.
We will also accept the assignment of benefits & file your claim on your behalf. We ask that you be familiar with your insurance benefits as it is a contract between you and them.
Please be aware our office does not file secondary insurance.
We file all insurance electronically, so your insurance company will receive each claim within days of treatment. Please note that some insurance carriers will not reimburse our office directly.
In such instances, you will be responsible for payment in full at the time treatment is completed & your insurance company will send you the reimbursement check directly. Call us if you have questions: Merhoff & Associates Pediatric Dentistry Phone Number 336-659-9500.
Please understand that there is no direct relationship between your dental insurance company and our office. Your insurance company is responsible for how they process claims and what benefits are payable on a claim.
We can only assist you in estimating your portion. We will verify your benefits prior to treatment whenever possible. If you have any questions we will be happy to assist you.
Interesting Insurance Facts:
FACT 1: NO INSURANCE POLICY PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients believe that their insurance pays 90%-100% of all dental fees. This is simply not true!
Actually, most insurance 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 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 independently. Frequently this data can be three to five years old leading to a larger profit margin for the insurance companies and a larger copay for you.
Unfortunately, this gives the misconception that your dentist is “overcharging” for their services. In general, the less expensive insurance policy will use lower UCR figures.
FACT 3: DEDUCTIBLES AND COPAYMENTS MUST BE CONSIDERED
Deductibles and coverage percentages must be considered when estimating dental benefits. Consider the following illustration assuming the fee for service is $150.
Assuming the insurance company allows $150 as its UCR fee, we can determine the payable benefits by the policy. First, a deductible, on average $50 and payable by you, is subtracted, leaving $100.
Then assume the plan will pay 80% for this particular charge. The insurance company will then pay 80% of $100 or $80. Out of a $150 fee they will pay an estimated $80 leaving a remaining portion of $70 to be paid by the patient.
Of course, if the UCR is less than $150 or if your plan pays at a lower percentage, then the insurance benefits will also be significantly less.
It is most important that you keep us informed of any insurance changes such as policy name, insurance company address, or change in employment so that we may continue to provide you with the most accurate estimate possible.
We appreciate your cooperation and understanding.
Please notify us if your dental coverage is embedded in your medical policy. Although we are unable to file to medical insurance companies we will gladly provide you with the necessary paperwork for you to submit your claim.
Note: All policies are subject to change without notice.
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Diet & Cavity Prevention
How do I know if my child is getting the appropriate amount of fluoride in their diet?
If you do not reside in a community that has fluoridated water or have the appropriate amount of natural fluoride in your well water, your child will need some sort of supplement in their diet. We can help you determine how much of a supplement your child needs based upon their weight, age, current water fluoride level, and brand of toothpaste.
What is an appropriate diet for my child?
It is important that your child receives a naturally-balanced diet that includes the important nutrients your child needs in order to grow. A daily diet should includes the major food groups of meat/fish/eggs, vegetable/fruit, bread/cereal as well as milk and other dairy products.
Can my child’s diet affect their dental health?
Absolutely! It is important that you initiate a balanced diet for your child so that their teeth develop appropriately. In addition, this will positively affect healthy gum tissue surrounding the teeth. Please note that a diet high in sugar and other forms of carbohydrates, such as bread & crackers, may increase the probability of tooth decay.
How do I create a diet that is safe for my child’s teeth?
Analyze the frequency in which starch-based foods are eaten. These types of foods include breads, pasta, potato chips, etc. In addition, sugar is found in more than just candy. All types of sugars can promote tooth decay. For example, most milk-based products contain sugar. A peanut butter and jelly sandwich is a favorite for bagged lunches. Unfortunately, it includes sugar not only in the jelly, but also in the peanut butter. For less sugar and more flavor and nutrients, try replacing jelly with fresh fruit slices (apples, pears, or bananas) or chopped dried fruit. Go easy on the peanut butter, though — it’s high in fat. Choose the “no-salt-added” kind for less sodium.
Should I eliminate all sugar and starch from my child’s diet?
Of course not. Many of these foods are incredibly important to your child’s health. Starch-based foods are much safer to eat for teeth when eaten with an entire meal. Foods that stick to teeth are also more difficult to wash away by water, saliva, or other drinks. It’s important that you talk to our staff about your child’s diet and to maintain proper dental care.
What helpful information can you give me regarding tooth decay in infants?
Most importantly, don’t nurse your children to sleep. Do not put them to bed with a bottle of milk, juice, or formula. When a child is sleeping, any liquid that remains in the mouth can support the bacteria that produce acid and harm the teeth. A simple pacifier or bottle of water is fine.
What Is Fluoride?
Fluoride helps make teeth strong and prevents tooth decay. If the water where you live does not have enough fluoride, your doctor may prescribe fluoride supplements (fluoride drops or pills). You would give these drops or pills every day, starting when your child is about six months old. Only give as much as the directions say to use because too much fluoride can cause spots on your child’s teeth. Also, be sure to call your local water authority and ask if your water is fluoridated. If it is, tell your dentist or pediatrician so that your child is not being over fluoridated. Children should take these drops or pills until they are 12 to 16 years old (or until you move to an area with fluoride in the water).
Have Further Questions?
What are sealants?
Tooth sealant refers to a plastic that a dentist bonds into the grooves of the chewing surface of a tooth as a means of helping prevent the formation of tooth decay.
How do sealants work?
In many cases, it is nearly impossible for children to clean the tiny grooves between their teeth. When a sealant is applied, the surface of the tooth is somewhat flatter and smoother. There are no longer any places on the chewing part of the tooth that the bristles of a toothbrush can’t reach and clean. Since plaque can be removed more easily and effectively, there is much less chance that decay will start.
What is the life expectancy of tooth sealants?
The longevity of sealants varies. Sealants that have remained in place for three to five years would be considered successful, however, sealants can last much longer. It is not uncommon to see sealants placed during childhood still intact on the teeth of adults. Our office will check your child’s sealants during routine dental visits and will recommend repair or reapplication when necessary.
Which teeth should be sealed?
Any tooth that shows characteristics of developing decay should be sealed. The most common teeth for a dentist to seal are a child’s back teeth, and of these teeth, the molars are the most common teeth on which dental sealants are placed. The recommendation for sealants should be considered on a case-by-case basis.
What is the procedure for placing sealants?
Generally the procedure takes just one visit. Placing dental sealants can be a very easy process. The tooth is cleaned, conditioned, and dried. The sealant is then flowed onto the grooves of the tooth where it is hardened with a special blue light and then buffed. All normal activities can occur directly after the appointment.
How important is brushing and flossing after sealants are applied?
It is just as important for your child to brush and floss their teeth. Sealants are only one part of the defensive plan against tooth decay.
How much does it cost?
This treatment is quite affordable, especially when you consider the value of protection against tooth decay. Most dental insurance companies cover sealants. Check with your insurance company about your child’s coverage.
Sealants protect the depressions and grooves of your teeth from food particles and plaque that brushing and flossing can’t reach.
Easy to apply, sealants take only a few minutes to seal each tooth. Sealants hold up well under the force of normal chewing and can last several years before a reapplication is needed.
Children and adults can benefit from sealants in the fight against tooth decay.
What is a mouth guard?
A mouth guard is comprised of soft plastic. They come in standard or custom fit to adapt comfortably to the upper teeth.
Why is a mouth guard important?
A mouth guard protects the teeth from possible sport injuries. It does not only protect the teeth, but the lips, cheeks, tongue, and jaw bone as well. It can contribute to the protection of a child from head and neck injuries such as concussions. Most injuries occur to the mouth and head area when a child is not wearing a mouth guard.
When should my child wear a mouth guard?
It should be worn during any sport-based activity where there is risk of head, face, or neck injury. Such sports include hockey, soccer, karate, basketball, baseball, skating, skateboarding, as well as many other sports. Most oral injuries occur when children play basketball, baseball, and soccer.
How do I choose a mouth guard for my child?
Choose a mouth guard that your child feels is comfortable. If a mouth guard feels bulky or interferes with speech to any great degree, it is probably not appropriate for your child.
There are many options in mouth guards. Most guards are found in athletic stores. These vary in comfort, protection as well as cost. The least expensive tend to be the least effective in preventing oral injuries. Customized mouth guards can be provided through our practice. They may be a bit more expensive, but they are much more comfortable and shock absorbent.