
Effective February 1, 2007, this office has discontinued our formal participation agreement with the United Federation of Teachers Welfare Fund. However, we will continue to accept the UFT plan as payment toward our fee. Patient out of pocket payments will be limited to any costs beyond the UFT benefit.
This office will also accept benefits for covered services as payment-in-full, after any deductibles and co-payments, from the New York City Police Benevolent Association (PBA) Active and Retirees, and District Council 37 Health & Security Plan (DC37), for BASIC SERVICES ONLY. For these plans, there will be an additional co-payment for any services requiring a laboratory technician's services, i.e., crowns, fixed bridges, and removable prosthodontics (dentures). We DO NOT currently have a contractual arrangement with these groups.
For your convenience, we have provided an insurance claim form that you can fill out online and print in preparation for your visit to your dentist's office. JUST FOLLOW THIS LINK... and the form will open in a new window. Information that you enter in the form will not be collected, saved, or sent. Please note that you must have Adobe Acrobat Reader installed on your system to view the claim form.
--then a Direct Reimbursement Dental Benefits Plan may be right for you! A DR plan can be tailored to meet the needs of both small and large companies. Have your employer inquire about enrolling in a Direct Reimbursement Plan. Information is available from the American Dental Association.
Please understand that ultimate responsibility for payment of fees associated with services rendered rests with the recipient(s) of dental services or his/her/their legal guardian/responsible party. This office is not an agent or employee of the insurance companies with which we have a contractual arrangement, and we cannot guarantee that benefits will be payed by them in your behalf. Office policy is to make a good faith effort to file claims with, and collect benefits from legitimate insurance entities for individuals covered by them. Responsible parties will be responsible for initial payments of any pre-determined deductible or co-payment amounts. Reconciliation of all balances, if any, after payment of insurance benefits is the responsibility of the patient or responsible party.
The material falsification of a dental claim in any way (nature, date of service, patient name, etc.), or the forgiving of a copayment is considered insurance fraud, a felony in New York State. Please do not ask our office to perjure itself. Thank you for understanding!
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