INSURANCE PAYMENT OPTIONS

Great oral health is an essential part of a healthy lifestyle, therefore we have prepared this section to help you better understand the complexities of dental insurance; we realize how confusing it can be. To begin we would like to highlight a misconception- dental insurance was not designed to pay for all dental care. Most contracts have limits and/or various degrees of co-payment. All levels of payment by insurance companies, including allowed fees, usual and customary, are governed by the premiums paid. They have nothing to do with the actual charges. Our fees are based upon a combination of our costs, our time, and our constant dedication to supplying our patients with the highest quality dental care. The treatment recommended by our office is never based on what your insurance company will pay; your treatment should not be governed by your insurance contract. However, it should be understood, that the dental insurance contract is between the insurance company and the patient, whom bears the ultimate financial responsibility. 

 

Dental Insurance, What is it anyway and how does it work?

Dental insurance is a type of health insurance designed to pay a portion of the cost associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories they are:

  1. Indemnity - most commonly referred to as true dental insurance or free choice of dentist allowing you to see any dentist of your choice who accepts dental insurance.
    • helpful when you want to stay with your dentist and he or she does not participate in a dental network.
    • Insurance companies generally pays the dentist a percentage of your services according to the policy purchased.
    • Co-payment requirements, waiting periods, and deductible are much more stringent.
  2. Preferred Provider Network - referred to as (PPO), Depending on your specific plan, the PPO works similar to DHMO giving you the choice to see a dentist within the network, out of network, or a non-participating provider.
    • Depending on your plan, the PPO works similar to a DHMO
    • Difference of fees will become the financial responsibility of the patient unless otherwise specified in your dental policy.
    • May have an annual maximum benefit
    • Each year the annual maximum is renewed and reissued for coverage for your new benefit year. (maximum may renew and start January per calendar year, the companies fiscal year, or based on plan enrollment)
  3. Dental Health Managed Organization - referred to as (DHMO) in which you are assigned or select an in-network dentist and/or in network dental office and use the dental benefits in that network.
    • Dentists signs a contract with insurance company and the provider agrees to accept an insurance fee scheduled and give their customers a reduced cost for services as a in-network provider.
    • May have little or no waiting periods
    • No annual maximum benefit limitations
    • Covers major dental work near the start of the policy period.

 

Every person’s situation is different and all plan benefits are subject to the provisions and limitations of the plan and are not guaranteed.  Even if you don’t see your insurance here or you don’t currently have insurance, we’ll be able to help you. 

We are a PPO provider, we accept many private insurance plans. This mean s that we work with literally hundreds of companies.

If you need help understanding your insurance and potential costs for in and out of network expenses, call us now to discover what options are right for you.