First Visit
Welcome and thank you for choosing Lantzy Children's Dentistry for your dental health concerns. We are committed to providing you with the highest quality dental care in an efficient, timely, and cost effective manner. We hope that by providing you with our policies in advance, we can prevent any misunderstandings or frustration at the time of your visit.
Appointments
Check - In: Please arrive for your appointment a few minutes early so that all paperwork may be completed before you see the dentist. Please bring your current insurance card with you to each visit. On follow-up visits, you will be asked to verify demographic/insurance information so that our records remain up to date.
Late Arrivals: If you arrive more than 10 minutes past your appointment time, you may be rescheduled so that other patients are not inconvenienced.
No Shows and Late Cancellations: We require 24-hour notice if you must cancel your appointment. If you cancel any appointment with less than 24 hours notice, a $35 missed appointment/broken reservation fee will be collected before any further appointments can be scheduled/rescheduled. This fee will be enforced solely at the discretion of representatives of Lantzy Children’s Dentistry. Patients that are more than 10 minutes late may be rescheduled and may also incur the $35 missed appointment/broken reservation fee. AFTER THREE MISSED OR CANCELLED APPOINTMENTS WITH LESS THAN 24 HOURS NOTICE YOU WILL BE DISMISSED FROM THE OFFICE.
Minors: The parents/guardians accompanying a minor are responsible for providing current insurance information for the minor and/or payment in full for services provided. Children accompanied by a non-legal guardian/caretaker must have a written authorization for dental treatment signed by the parent or guardian before treatment can be rendered. The parents/guardians accompanying a minor are responsible for providing current insurance information for the minor and/or payment in full for services provided. Children accompanied by a non-legal guardian/caretaker must have a written authorization for dental treatment signed by the parent or guardian before treatment can be rendered.
Check - Out: We accept CASH, CHECKS, MASTERCARD, VISA, DISCOVER, AMERICAN EXPRESS and CARE CREDIT. Please be prepared to pay for the current visit as well as any past balances on your account. Payment of co-pays, deductible, supplies or any non-covered services will be required at the time of service. Estimated patient responsibilities for surgical procedures and office care will be determined by insurance estimates.
What to Expect at Appointments
Dr. Lantzy suggests x-rays at every 6 month recall appointment. ADA/FDA guidelines are followed when requesting dental x-rays. These guidelines are used to optimize patient care, minimize radiation exposure, and allocate healthcare resources responsibly. In some circumstances, x-rays may be taken once per year if patient meets criteria which exclude them from high risk category.
Patients ages 3 and under, will have a knee to knee appointment with a toothbrush prophylaxis. As your child’s comfort level advances, they will progress to the dental chair for x-rays and prophylaxis cleanings with a hygienist.
NEW patients, ages 5 and under, will have 2 occlusal films (taken at initial comprehensive appointment and on an as needed basis for following office visits) and 2 bitewing films (taken to evaluate for decay between teeth that is not visible to the eye).
NEW patients, ages 6 and up, will have a panoramic film (taken every 3 years to monitor growth and development) and 2 bitewing films (to evaluate for decay between teeth that is not visible to the eye).
Existing patients, will have, at minimum, 2 or 4 bitewing films taken (depending on patient age and mouth structure) at every 6 month recall appointment.
For all patients, periapical films are taken on an as needed basis, typically for emergency or pain related situations.
Please note that all x-rays are subject to change depending on the child's level of comfort.
Insurance
When making an appointment with our office, it is your responsibility to confirm with your insurance company that the dentist is currently under contract with your plan.
As of January 1, 2010, our office is no longer accepting DMO policies. Please contact us to assist you with any questions you may have regarding other insurance, payment options or care credit opportunities.
For your convenience, we file with all PPO insurance companies. However, please note that we do NOT file Secondary Insurance. Please contact our office to find out which insurance companies we are in network with.
Medicaid, Medicare & Chips are NOT accepted.
CONTRACTED INSURANCE: If we are contracted with your insurance company, we must follow our contract fees and agreement. If you have a co-pay or deductible, you must pay at the time of service. It is the insurance company that makes the final determination of your eligibility. If your plan requires that you have a referral prior to seeing a specialist, please contact your primary dentist so that you have the referral in hand at the time of your appointment. We do accept faxed referrals; however, we advise you to call prior to your appointment time to be sure we have your referral. If we do not have a referral at your appointment time, we will need to reschedule your visit, unless you choose to be seen without using your insurance benefits and pay for your visit in full. If your insurance should happen to change, we require that you notify our office 24 hours prior to your appointment time.
NON CONTRACTED INSURANCE: Insurance is a contract between you and your insurance company. We are NOT a party to this contract, in most cases. We will bill your primary insurance company as a courtesy to you. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility. If you have a co-pay or deductible, you must pay at the time of service. You agree to pay any portion of the charges not covered by insurance. If your insurance requires a referral and/or preauthorization this could result in a lower payment from the insurance company leaving you to pay the remaining balance.
The responsible party is responsible for knowing their benefit coverage for specialist visits. We gladly file your insurance claim on your behalf. We allow 45 days from the date the claim is filed for the insurance company to pay. If your carrier does not pay within this time, you could be responsible for the entire balance. We will not become involved in disputes between you and your insurance company regarding coverage and/or policy benefit criteria, i.e. deductible, non-covered services, co-insurance, coordination of benefits, pre-existing conditions or reasonable and customary charges, etc, other than to supply factual information when necessary.
You are responsible for deductible, co-insurance, non-covered services, and any other charges your insurance may not cover. You will be sent statements by mail and/or email on a monthly basis regarding any monies owed by you, the patient. If the same balance becomes more than 3 months past due, you will then be charged a finance charge of $10.00 each month thereafter until the balance is paid in full. In the event your account is turned over to The American Credit Bureau and/or a collection agency, all fees associated with the collection of your account will be added to your balance when reporting to the collection firm.
DIVORCE: In case of divorce or separation, the party responsible for the account prior to the divorce or separation remains responsible for the account. After a divorce or separation, the parent authorizing treatment for a child will be the parent responsible for those subsequent charges. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent’s responsibility to collect from the other parent. Within the State of Texas, events do not change the responsible party, one parent cannot name another parent as the responsible party, and both parents are responsible.
TRANSFERRING OF RECORDS: You will need to request in writing if you want to have copies of your records sent to another doctor or organization. You authorize us to include all relevant information, including your payment history. If you are requesting your records to be transferred from another doctor or organization to us, you authorize us to receive all relevant information, including your payment history.
In some cases, we may require a $25 Release of Records fee, as approved by the Texas Administrative Code. This fee will be enforced solely at the discretion of representatives of Lantzy Children’s Dentistry.