What are the advantages of using an in-network dentist?
An in-network dentist is contracted with your insurance company to be a preferred provider. This means he accepts the fee schedule set by your insurance company. This will save you hundreds of dollars over a dentist who is out-of-network. Most in-network dentists do the same high quality dental work with insurance patients as they do with non-insurance patients.
What are the advantages of using a dentist who is out-of-network?
There are some good and bad in-network dentists and there are some good and bad out-of-network dentists. Just because a dentist is out of network for your insurance company does not mean he is a superior dentist. If you find a good in-network dentist that can save you money, why not try him?
How can I know if a dentist is an in-network provider for my insurance company or not?
This can be tricky. Most of the dentists that are out-of-network and are not providers for your insurance company will usually say to the new patient caller, “Yes, we accept your insurance and we will gladly bill your insurance for you.” By saying they “accept your insurance” does not mean they are in-network, so they can charge you their standard fees which are hundreds of dollars over the in-network fees. You need to say, “I have XYZ PPO dental insurance. Is your office an in-network provider for my insurance company?” This has to be a yes or no answer, not, “We accept your insurance”. We don’t play these games with our patients. We are an in-network provider office for most dental PPO’s (sorry, no HMO’s or Medi-Cal).
How can I know for sure you are an in-network dental office?
Call us and give us your dental insurance information. We will call your insurance company to see if you are covered by them, what is the annual maximum amount for each person in the family, what procedures are covered or not and at what percent, and what are some of the restrictions.
What is the difference between a PPO and an HMO?
A Preferred Provider Organization (PPO) office is contracted with that PPO. They accept the insurance company fee schedule as their fee schedule for patients who have that plan. You have more choices of dentists to choose from with a PPO plan. An Health Maintenance Organization (HMO) office is contracted with that HMO. An HMO plan usually costs less than a PPO plan because fewer dental procedures are covered. Patients who have an HMO plan have to go to certain dental clinics and have fewer dental offices to choose from. If you have a choice at work, pick the PPO plan. You have a bigger selection of dentists and the treatment is usually better.
I need a dentist who takes my PPO insurance. What dental insurance PPO’s do you take?
We are an in-network provider dental office for Delta Dental, Aetna, some Blue Cross plans, CCOPA, Cigna, GEHA, Guardian, Metlife, Physicians Mutual, Principal Life, Tri-Care Retiree, United Concordia, Washington Dental Service, and a few others.
Do you take Delta Dental?
Yes, we are an in-network provider for Delta Dental Premier and Delta Dental PPO. (Sorry, no Delta Dental HMO.)
Do you take HMO dental insurances or Medi-Cal patients?
We are not a provider for any HMO, Medi-Cal, or welfare program. You must call around and find an office that is in-network for those plans.
What are the advantages and disadvantages of going to a big dental clinic?
The big clinics have the advantage of being open more hours compared to a private dental practice. However, they often have a different dentist work on you for each visit and you often have to wait a long time to be seen.
What are the advantages and disadvantages of going to a private dental practice?
Private non-clinic dental offices usually have 1-2 dentists only. You will probably see the same dentist for each visit. They usually schedule reserved appointment times so you are not waiting a long time to be seen. The dentists in private offices are usually more experienced.
Can my family and I share our annual insurance maximums?
No. Each member of the family has their own maximum allowance. For most insurance companies it is $1500-$3000.
Why doesn’t my insurance plan cover the whole cost of treatment?
When a dental office is in-network with an insurance PPO, they are contracted to accept the PPO fees for the PPO patients with that plan. They are also contracted to accept a co-payment amount from the patient for each procedure. For example, the PPO fee for a filling may be $120 and the rate is 70%. The insurance company will pay $84 and the patient will pay $36. The office is contracted not to waive the patient portion. The dental office is also asked to collect a “deductible” amount each year from each patient (usually $50-100). Once the deductible is paid, then the insurance company will pay their percentages. There are other restrictions and rules that the contracted office has to follow.
Is it guaranteed that the insurance company will pay what they say they will pay?
Unfortunately, no. Sometimes they say they will pay for something then change their minds. When that happens, the patient is responsible for the whole dental fee. We cannot guarantee what an insurance company will pay. We can only provide you with an estimate.
Why do insurance companies deny dental procedures that are supposed to be covered?
Sorry, but the dental insurance companies are mainly worried about their bottom line and their profits. If there is a way to reduce the amount they have to pay out in benefits, they will do it. This is why insurance company CEO’s make millions every year.
Why did my insurance company deny my dental crown?
Some dental insurance companies are not very honest. They will do anything they can to avoid making payments. There is no guarantee they will pay what they say they will pay. Often their clerks that review the payment requests have a quota to meet. Once they have reached a certain amount of payments going out for any given month, they will stop making payments. Often, they have clerks reviewing the payment requests and they are the ones who deny payment, not a licensed dentist.
Do insurance companies cover all dental procedures?
No. There are limitations. Each insurance company is different. They cover fees differently. They have different annual maximums. They have different percentages of coverage. They have different waiting periods. Talk to our staff. They are excellent in estimating what insurance plans will cover.
How can I know for sure if a dental procedure is going to be covered by my insurance company plan?
We can never say for sure if your insurance company will cover your needed dental work. There is no guarantee. We usually call ahead of time to check on eligibility and coverage. Usually we will pre-authorize major dental work. Even when we have those pre-authorizations in our hands, we have seen insurance companies back out of their agreement. We do the best we can to get you the most benefits. You may have to call the insurance company to fight for your benefits. If they still deny a claim, the patient is responsible for the full payment.
If I need to find a new dentist who is in-network with my insurance PPO, or if I need a toothache treated, who can I call?
Try us. We are an in-network provider for most major dental insurance PPO’s. We are open Monday-Thursday and some Fridays. We treat most dental emergencies. Our office staff is great with answering your insurance questions and getting the most out of your insurance benefits. Give us a call.