Understanding Your Treatment Plan


At the end of an exam, we will present you with a Treatment Plan.  This is a comprehensive statement of the procedures determined by the doctor as necessary to restore you to optimal dental health.  It will outline what services are needed, the order of their importance and the tooth number and surface each procedure needs to be performed on.  It will also outline the fees associated with these treatments and your insurance coverage, if applicable.  Any mention of insurance coverage is always an estimation and never a final guaranteed determination.  This document is handy to keep for planning your future appointments.  It will help you keep track of what has been completed and what might be due for payment at any given phase.  It is also handy as a reference to look back on, if you choose to delay treatment.  We are always available to answer any questions about your care and the items detailed on your Treatment Plan.  Never hesitate to ask!

 PHASE

Phase

Each phase corresponds to a visit or appointment. We phase your treatment plan for you so that you may see what procedure is being performed at each visit and what is due at each visit.

DATE PLAN

Date Plan

This is the date the plan was created for you. This is not your scheduled appointment date for an upcoming procedure.

PROVIDER

Provider

 This is the code to identify the provider assigned to perform your procedure.

 SERVICE

Service

The number beginning with a D is the Dental Procedure Code which serves to provide for the efficient processing of dental claims and to populate an Electronic Health Record. The name of the procedure follows the Dental Procedure Code. Often, the name is abbreviated to fit on one line. Please ask questions if you are unsure of what the procedure is and what it entails. The doctor should explain your recommended treatment and his assistant should ensure your questions are answered. Our website has a great dictionary for additional assistance.

Here you will also see:

STANDARD FEE – This is our normal fee we charge for the detailed procedure

Standard Fee

ADJUST – This is where you see the difference between what we normally charge and the amount we are allowed to charge, as per your insurance company. When we agree to accept your insurance, we are contracted with your insurance company to charge their fees, not ours.   Every insurance company is different. You receive the reduced fee even if you have received your maximum allowed benefits for the year (typically $1,000 to $1,500 depending on your insurance).

TTH TTH

This is the tooth number the procedure is being proposed for. Upper teeth are numbered 1-16 and lower teeth are 17-32. You may not have all 32 teeth, but the numbers remain fixed as if they were present.

Teeth Number Chart 

SURFACE

Surface

 This is the surface of the tooth the procedure is being proposed for.  Again, our dental dictionary comes in handy here.

 Tooth Surfaces

FEE Fee

This is the fee we are charging for the procedure. This fee is the contracted rate determined by your insurance company if you have insurance. If you do not have insurance, this is simply our standard fee.

INS

INS

This is the amount we are estimating your insurance will pay from your maximum allowed benefits. It is important to note that this is just an estimate. Many factors will determine, if in fact, your insurance company will pay this amount. We do our best to show an accurate number, but since your insurance company makes the final determination, sometimes this number is reduced and we do not find out until after the procedure is performed.

PAT

PAT

This is the amount you as the patient are estimated to pay after your insurance is considered. Because the number that appears is the INS column is just an estimate, this number too is only an estimate. This number is often referred to as your “out of pocket” expense.

TOTAL PROPOSED

TTL Proposed

This is the total amount due if you completed all items on your treatment plan and your insurance company DID NOT pay out any benefit. Note that this total is the sum total of your contracted insurance rates which DO provide a significant discount. If you have reached your maximum allowed benefits for the year (typically $1,000 to $1,500 depending on your insurance), you do still continue to receive discounted rates through your insurance company. If you are interested in seeing how much you have saved, you could total up all the STANDARD FEES listed in each SERVICE and compare it to our TOTAL PROPOSED.

TOTAL COMPLETED

Completed

If you have received a Treatment Plan from us in the past and we have performed some of the procedures and if we are now offering you an updated Treatment Plan, the sum here is the total sum of the work completed.

TOTAL ACCEPTED

Accepted

If you have received a Treatment Plan from us in the past and agreed to perform some of the procedures and if we are now offering you an updated Treatment Plan, the sum here is the total sum of the work you agreed to complete.

PROPOSED INSURANCE

Proposed Ins

This is the total amount we are estimating your insurance company will pay towards your TOTAL PROPOSED. Most insurance plans have a maximum allowed benefit for the year of $1,000 to $1,5000. It is important to note that this is just an estimate. Many factors will determine, if in fact, your insurance company will pay this amount. We do our best to show an accurate number, but since your insurance company makes the final determination, sometimes this number is reduced and we do not find out until after the procedure is performed. We recommend that you be prepared to spend a range of TOTAL PROPOSED in its entirety and TOTAL PROPOSED less PROPOSED INSURANCE.

NOTES

Because we deliver the finest care at the most reasonable, we require payment at the time service is rendered unless other arrangements have been made in advance. If you have questions regarding your account, please contact us immediately. Many times, a simple telephone call will clear any misunderstandings. Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage. We will send you a monthly statement. Most insurance companies will respond within four to six weeks. Any remaining balance after your insurance has paid becomes your responsibility.   Arrangements for a monthly payment plan can be made, but this must be done prior to the actual procedure.

PATIENT INITIALS

We ask you to sign the Treatment Plan (outside of the consent box) that we have presented to you. This does not serve as consent to perform the treatment, nor is it a contract where you are agreeing to perform and pay for these procedures. Your signature or initials serve as an acknowledgement that you have been presented with this Treatment Plan and that you are aware the of the prescribed treatment for you and the costs associated with each procedure.  If you agree to the Treatment Plan and are ready to schedule, then you would sign this box which DOES serve as your consent and your willingness to pay the fees outlined in your plan:

Consent