Insurance Explained

Do you “File my insurance”?

Good question. The answer is YES. We will file your dental insurance. We are not in- network with any plans, which means whatever your dental insurance does not cover, you are responsible for.

  • We file all your claims, so you will not have to deal with the headache.

  • We can explain your coverage so there are no surprise bills after treatment is completed

  • We can pretreat any procedure so you can know for certain, what your plan will cover. 

We choose not to participate with most plans simply because we value quality over quantity. Spending more time with our family of patients allows us to better understand their goals, needs and preferences. 

How does dental insurance work?

  • You pay a premium, a certain amount monthly, to buy the plan.

  • Your deductible is what you must pay out-of-pocket for services covered by your plan before the insurance company pays.

  • Your plan may include copays, a fixed cost you pay for a certain service, like an X-ray.

  • Coinsurance refers to the percentage you pay of covered expenses after you meet your deductible. So, if your coinsurance for a filling is 30%, and the cost for that service in-network is $100, you would pay $30 of that. The insurance company would pay for the rest of your covered expenses up to your annual maximum

Are there limits on what dental insurance will pay?

Yes. Dental plans generally come with annual maximums, which is the most the insurance will cover in a given calendar year. Those maximums vary depending on the plan and insurance provider, but generally range from $1,000-$3,000. 

Does dental insurance cover more involved procedures?

Yes. Most cover dental work like fillings, extractions, and root canals. What services are covered and how much insurance will pay vary greatly by plan. Orthodontics and implants are particularly confusing. Ortho coverage often has an age limit so pay careful attention to this part of your plan. Implants often have what is known as a “rider” and “missing tooth cause.” Without going into too much detail they are ways insurances often try to get out of paying for these procedures leaving you totally out of pocket. Reach out to our office to find out more about these details. 

What is the difference between “IN NETWORK” and “OUT OF NETWORK”?

This refers to a contractual agreement between a provider (your dentist) and an evil insurance over lord (your insurance company). As an in-network provider, the dentist agrees to accept a lower fee schedule in exchange for the “privilege” of seeing a volume of clients from an insurance company. As the participant in such an arrangement, it is reasonable to expect a lower out of pocket cost for some larger procedures. Preventative work (cleanings, exams, x-rays) are all covered at 100% provided there is not a provision in your insurance plan that forbids you from going to an out of network provider. Larger procedures often have an out of pocket cost that is slightly more out of network than in network. The beauty of all of this is that you have complete freedom in picking a practice that you know will take good care of you and not simply weigh the economics of just another insurance providers patient.

If you should have any questions about your dental insurance, please contact our office and we’ll be happy to guide you.