Insurance

Our Doctors participate with the following dental plans:

  • Aetna Dental PPO
  • Cigna PPO
  • Delta Dental Premier/Advantage
  • Gurdian PPO
  • Horizon Blue Cross (Dental Option ONLY)
  • Metlife
  • United Concordia

We also accept the following discount plans: Cigna Savings and Aetna Savings.

We accept CareCredit for our patients without dental insurance.

If your dental insurance is with a provider that we do not participate with please note that most insurance companies allow for out of network providers and we will provide you with a doctor’s statement to send to your insurance for reimbursement. We are pleased to be able to offer Care Credit with 6 months free financing for all treatments over $200.

Payment is required at time of treatment, unless other plans were made in advance. We provide several means of payment for your convenience and budget. You can pay with personal checks, cash, and a wide range of debit and credit cards. We are also partners with CareCredit.

We will file your insurance claims for you if all your insurance data are ready on the day of your visit. Make sure you familiarize yourself with the details of your insurance benefits, because we will need you to make payment for the portion of treatment your insurance does not cover.

Your insurance company is required by law to redeem each claim, not later than 30 days after receipt. We process claims promptly and get in touch with your insurance company shortly following treatment. It is your responsibility to settle all outstanding bills on your account after 30 days of treatment, whether your insurance company has paid or not.

Please note it is not our responsibility to file insurance claims but we do so as a service to our patients. We have no authority over how and when your insurance company processes your claims. We can only help you determine what portion of treatment your insurance does not cover.

Fact 1- NO INSURANCE PAYS 100% OF ALL PROCEDURES

Dental insurance is designed to help with accessing quality dental care. It by no means suggests complete coverage of your dental treatment bills. In general, insurance covers only fifty to eighty percent of treatment. The actual coverage varies from one company to the next. The percentage of coverage depends on the type of insurance policy your employer has with the insurance company, and the premium you or your employer has paid for this policy.

Fact 2- BENEFITS ARE NOT DETERMINED BY OUR OFFICE

It is entirely up to your insurance company to determine the percentage of treatment cost reimbursed to you or your dentist after processing your claim. Sometimes, the reimbursement comes at a rate lower than the dentist charged. Most often, insurance companies state that the dental office charge was above the insurance company’s acceptable UCR (usual, customary, or reasonable fee).

This gives the false impression that your dentist is charging more for similar treatments among dentists in the same location. This is simply not true. More realistically, the insurance company is underpaying their insurance obligation. In general, a low UCR quote is associated with a less expensive insurance policy.

Fact 3- DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED

Make sure you understand your role in payment of your insurance claims, and how to calculate the variables. Let us assume that the treatment fee is $250.00, and your insurance company has a UCR fee of $250.00. This gives us an idea of what will be paid as benefits. The first computation you will apply to the fee is the amount you are expected to bear – this is usually $50.00. This amount is deducted, leaving a balance of $200.00. If the insurance company will pay 80% for this treatment, it does not mean 80% of the treatment fee. The 80% is on the remaining amount after the deductible has been applied, in this case, 80% of $200.00, which is $160.00. Therefore, out of a bill of $250.00, the insurance will cover $160.00, leaving the rest ($90) to be borne by the patient. Kindly note that this figure depends on the UCR the insurance company uses. If the UCR is less than the treatment fee of $250.00, or your policy only covers 60%, the amount that makes up your insurance benefits will be comparatively lower.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

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