Dental Insurance

Dental Insurance

We accept most PPO plans.  We do not accept Denti-cal, HMO or DMO plans. Please contact our office for more information

There are two ways to submit claims to your insurance company. 

Option 1 is to have patient pre-pay the full amount of all the dental services rendered.  The patient will file the claim to the insurance company for reimbursement.  The average time for claim processing is 60 days.

Option 2 is to sign a release form to assign dental benefits to the dentist.  After verification of insurance coverage, the patient will be given an estimate for patient co-payment or out-of-pocket cost.  The guarantor pays the estimated patient co-payment directly to the dentist, and the dentist will file the claim with the insurance company.  If there is a discrepancy between the estimated and actual dental benefits received, the guarantor will either be billed for the balance or receive a refund for overpayment.

The insurance policy is an agreement between the insured or insured’s employer and the insurance company, not between the insurance company and this office.  If the insurance plan pays for a downgraded benefit, the guarantor will be responsible for the difference between the fee for the actual procedure and the downgraded fee.  If the insurance plan does not pay in full for any reason (employment changes, reduction in benefit, change in patient status, treatment costs exceeded annual maximum benefits), the guarantor will be responsible for the remaining balance of the treatment.  Therefore, it is the patient’s responsibility to understand the insurance benefit and policy prior to initiating treatment.  Most insurance plans do not cover cosmetic dentistry or implant surgery, therefore patients are expected to pre-pay for these procedures unless there is written pre-approval from their insurance.

Patient co-payment is payable to the dentist at the time of service.   Most dental insurance plans will break down benefits according to

1-Preventive 2-Basic & 3-Major.  Each category will have a different coverage benefit based on percentage.  An annual deductible may be applied to your treatment before insurance benefit starts coverage.  Sometimes, insurance plans will downgrade a coverage based on least expensive alternative treatment (LEAT).  For example, resin or white filling will be downgraded to amalgam or silver filling.