Our office attempts to schedule appointments at your convenience and when time is available. We offer convenient hours, including early morning appointments. Preschool children should be seen in the morning because they are fresher and we can work more slowly with the child for their comfort. School children with a lot of work to be done should be seen in the morning for the same reason. Dental appointments are an excused absence. Missing school can be kept to a minimum when regular dental care is continued.

In most cases, if your child is over the age of 2, we ask that you allow them to accompany our staff, by themselves, through the dental experience. We are all highly experienced in helping children overcome anxiety. Separation anxiety is not uncommon in children, so please try not to be concerned if your child exhibits some negative behavior. This is normal and will soon diminish. Studies and experience have shown that most children over the age of 3 react more positively when permitted to experience the dental visit on their own and in an open environment designed for children.
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If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. Your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. If you have not paid your balance within 60 days a finance charge of 1.5% will be added to your account each month until paid. We will be glad to send a refund to you once insurance has paid us.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. 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, we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.

Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only 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 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 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 these "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 (UCR) figure.

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 (UCR) 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 patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.
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Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.

• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.

• Please dress your child in loose fitting, comfortable clothing.

• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.

• Your child should not have solid food for at least 6 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment.

• The child’s parent or legal guardian must remain at the office during the complete procedure.

• Please watch your child closely while the medication is taking effect. Hold them in your lap or keep close to you. Do not let them "run around."

• Your child will act drowsy and may become slightly excited at first.

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.

• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.

• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.

• Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.

For children who are unable to cooperate in the dental setting and/or have an extensive amount of dental care required, we recommend that their dental treatment be provided using intravenous (I.V.) sedation with a hospital trained dentist anesthesiologist. The medications used will allow your child to "sleep" through the procedure in a controlled and monitored setting allowing your dentist to provide the highest quality dental care.

Our dentist anesthesiologist is Dr. Jeffrey Fisher. The services he provides will enable your child to achieve a positive experience during his/her dental treatment. Dr. Fisher’s mission is to provide the highest standards of patient care and safety, in the comfort, convenient, and familiar surroundings of Dr. Work’s office.

Because of the extensive time, effort, and coordination necessary in scheduling, Dr. Fisher requires a non-refundable deposit of $350 prior to your child’s appointment being confirmed.

Prior to your child’s appointment, usually the evening before, Dr. Fisher will personally phone you at home. At that time he will review your child’s health history with you, explain the treatment in careful detail, and answer any questions that you might have concerning your child’s treatment.

Please read the following instructions pertaining to the day of treatment:

• Have your child wear loose, comfortable pants and a short-sleeved shirt.

• Please place a diaper or pull-up on your child if appropriate.

• Remove finger/toenail polish.

• Bring your child’s favorite warm blanket.

• Your child must not have anything to eat or during six hours prior to his/her appointment.

• Family members are not allowed in the operating room during the procedure.

On the day of treatment, your child will be given the initial sedative (an injection in the arm) in the reception area while you hold him/her. The effects of this medication are quite rapid (2-4 minutes) after which your child will stop responding to you verbally, and you will most likely see a blank stare on his/her face. After the sedative has taken effect, your child will be carried back to the treatment area. There, monitors for your child’s heart, blood pressure, oxygen saturation, respirations, and temperature will be applied and an I.V. will be established. Accompanying adults (parents/guardians) will remain in the reception area during the entire treatment. This is to ensure that the doctors are able to completely focus their attention on your child, thereby ensuring maximum safety and efficiency. After the treatment is completed and your child is starting to wake-up, the I.V. will be removed and you will be allowed to hold your child as he/she recovers. Both your dentist and anesthesiologist will personally give all post-operative instructions to you.

If you are unsure of anything or have additional questions, please contact Janine Cunha, RDA, at Dr. Fisher’s office, (925) 558-2720. We look forward to serving you and your child with the highest quality of care and safety in the near future.

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