As a courtesy to our patients, we participate with and accept most major PPO dental insurance plans and a few select discount plans. Please call our office to inquire if we participate with your plan.
You must understand that dental benefits are very different than medical insurance plans. Your dental benefits are not determined by the insurance company but by the plan your employer negotiates with the insurance company. This is because it is your employer who determines the benefit level offered to their employees.
Most plans have a deductible (typically ranging from $50 to $100) which the policy holder must pay before the insurance will make any payments. Each plan pays a specific percentage based on preventive (hygiene, sealants), basic (fillings) and major (crowns, bridges, etc) treatment. Each plan has a specific maximum limit and once you reach this limit, the insurance does not pay towards any more dental treatment until the policy renews. However, if you require treatment beyond the maximum that your insurance will pay, you should not delay treatment until your policy renews because you risk having your dental condition and treatment become more complicated and perhaps more expensive. We have a variety of payment options available to help you get the care you need right now rather than delaying.
We will provide you with an estimate of your patient portion (copay) that is expected at the time of service and submit insurance claims on your behalf. It typically takes 3-6 weeks to receive payment. Your insurance company typically sends you an Explanation of Benefit (“EOB”) that provides you all of the details on how they have processed the claim. Note that in some cases, they may not pay anything based on provisions in your contract. Once we have received payment from your insurance company we will provide you with a statement summarizing any remaining balance that you are responsible to pay. In the event your insurance company denies payment for any reason, you will be responsible for all charges incurred for your care.
If you have any questions about your insurance policy, you can consult your insurance carrier or your employer. We would also be happy to look into your policy and help you better understand your benefits.