Insurance/ Financial Responsibilities

  • We accept most insurance plans. If you have any questions regarding your benefits, please   ask our staff prior to your visit.
  • Please bring your insurance information, along with any forms, with you to your appointment.
  • We ask that you pay your co-payment at each visit.
  • We offer payment arrangements; however these must be arranged in advance of treatment.

Due to the many changes in insurance policies, it is no longer an easy task to interpret each individual policy. Although we try to stay aware of the changes, it is not always possible. Therefore, it is your responsibility to know your individual coverage. Failing to do so will result in you, the patient, being responsible for all costs incurred. Please remember that your insurance policy is between you and your insurance company, not between the insurance company and the dentist. If for any reason insurance does not pay in a reasonable time, payment will be expected from the patient. Most importantly, we are here to help in any way we can, and look forward to meeting your dental needs. Again, welcome to our practice!

Understanding your dental benefits is not easy. There are as many different plans as there are contracts. Your employer has selected your plan and is ultimately responsible for how your contract is designed. Remember, whether your plan covers a major portion of your dental bill, or only a small amount, dental benefits are good for patients because they help pay for needed treatment.

It is important to know that each contract will specify what types of procedures are considered for benefits. Even if a procedure is medically and dentally necessary, it may be excluded from your contract. This does not mean that you do not need the procedure. It simply means that your plan will not consider the procedure for payment. For example, cosmetic procedures and implants are often excluded from a dental plan.

It is a mistake to let benefits be your sole consideration when you determine what you want to do about your dental condition.

Many patients have questions regarding their dental benefits. While the employee benefits coordinator where you work can best answer your questions, the following may help.

Insurance FAQ

What insurance companies are accepted?

Delta PPO, BCBS, Blue Care Network, Cigna, Guardian, Humana, United Healthcare, ADN and Dentemax Network.  We dont accept Medicaid or any HMO plans.

Why doesn't my insurance cover all the costs for my dental treatment?

The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost.

But my plan says that my exams and certain other procedures are covered 100%.

That 100% is usually what the insurance carrier allows as payment toward the procedure, not what your dentist or any other dentist in your area may actually charge. For example, say your dentist charges $80 for an examination (not counting x-rays). Your carrier may allow $60 as the 100% payment for that examination, leaving $20 for you to pay.

If my plan does not really cover any procedures at 100%, why does it say it will?

Benefit plan booklets are often difficult to understand. If any part of your plan is not clear to you or if you think something is wrong concerning what your plan covers, you should contact your Employee Benefits Coordinator or the Human Resource department where you work.

How does my insurance carrier come up with its allowed payments?

Many carriers refer to their allowed payments as UCR, which stands for usual, customary and reasonable. However, usual, customary and reasonable does not really mean exactly what it seems to mean. UCR is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing is related to the cost of the premiums and there you are located in your city and state. Your employer has likely selected an allowed payment or UCR payment that corresponds to the premium cost they desire. UCR payments could be more accurately called negotiated payments.

Since the payments are negotiated, does this mean that there s always a balance left for me to pay?

Typically there is always a portion that is not covered by your benefit plan.

If I always have a balance to pay, what good is my insurance?

Even a benefit plan that does not cover a large portion of the cost of needed dentistry pays something. Any amount covered reduces what you have to pay out of pocket. It helps!

I received an Explanation of Benefits from my insurance carrier that says my dental bill exceeded the usual and customary. Does this mean that my dentist is charging more than he/she should?

Remember that what insurance carriers call usual and customary is really just what your employer and the insurance company have negotiated as the amount that will be paid toward your treatment. It is usually less and frequently much less than what any dentist in your area might actually charge for a dental procedure. It does not mean that your dentist is charging too much.

Is there an annual maximum on my benefits?

Yes. Maximums limit what a carrier will cover each year on your plan. Should you exceed your yearly maximum, you will be responsible for paying the dentist the balance for the services you had done.  We make every effort to make sure you dont go over, however, outstanding claims may prohibit us from having an accurate balance at the time services are rendered. It is your responsibility to notify us if you had treatments done in another office or with a specialist.

Why do some benefit plans require me to select a dentist from a list?

Usually the dentists on the list have agreed to a contract with the benefit plan. These contracts have restrictions and requirements. If you choose a dentist on the list, you typically will pay less toward your dental care than if you choose a dentist not on the list. If your dentist is not on the list, this does not mean that something is wrong with the dentist or the office.

 

Why won't my insurance pay anything toward some procedures, such as x-rays, cleanings, and gum treatments?

Your plan contract specifies how many of certain types of procedures it will consider annually. It limits the number of x-rays, cleanings, and gum treatments it will cover because these are the types of treatments that many people need to have frequently.

I know that my insurance plan doesn't go into effect until next month. Why won't my dentist do my treatment today, but send in the claim next month so that the insurance will pay?

State laws regulate these issues. It is insurance fraud to change the dates of service on a claim. Both the patient and the dentist can be prosecuted.


 

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A
Amalgam - Material made from mercury and other alloy mixtures used to restore a drilled portion of a tooth.
Anesthesia - Medications used to relieve pain.
Anterior teeth - Front teeth. Also called incisors and cuspids.
Arch - The upper or lower jaw.
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B
Baby bottle tooth decay - Caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby's mouth.
Bicuspids -A premolar tooth; tooth with two cusps, which are pointed or rounded eminences on or near the masticating surface of a tooth.
Bitewings - X-rays that help a dentist diagnose cavities.
Bonding - Application of tooth-colored resin materials to the surface of the teeth.
Bridge - A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements.
Bruxism - Teeth grinding.
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C
Calculus - A hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.
Canal - The narrow chamber inside the tooth's root.
Canines - Also called cuspids.
Canker sore - One that occurs on the delicate tissues inside your mouth. A canker sore is usually light-colored at its base and can have a red exterior border.
Caries - A commonly used term for tooth decay, or cavities.
Cold sore - Usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.
Composite filling - Tooth colored restorations, also known as resin fillings.
Composite resin - A tooth colored resin combined with silica or porcelain and used as a restoration material.
Contouring - The process of reshaping teeth.
Crown - An artificial tooth replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure. It is also placed on a dental implant.
Cusps - The pointed parts on top of the back teeth's chewing surface.
Cuspids - Front teeth that typically have a protruding edge.
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D
Dentin - The tooth layer underneath the enamel.
Denture - A removable set of teeth.
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E
Endodontics - A form of dentistry that addresses problems affecting the tooth's root or nerve.
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F
Fluoride - A harmless over-exposure to fluoride resulting in tooth discoloration.
Fluorosis - A harmless over-exposure to fluoride and resulting sometimes in tooth discoloration.
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G
Gingiva - Another word for gum tissue.
Gingivitis - A minor disease of the gums caused by plaque.
Gum disease - An infection of the gum tissues. Also called periodontal disease.
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I
Impacted teeth - A condition in which a tooth fails to erupt or only partially erupts.
Implant - A permanent appliance used to replace a missing tooth.
Incisor - Front teeth with cutting edges; located in the center or on the sides near the front.
Inlay - An artificial filling made of various materials, including porcelain, resin, or gold.
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L
Laminate veneer - A shell that is bonded to the enamel of a front tooth. The shell is usually thin and made from porcelain resin.
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M
Malocclusion - Bad bite relationship.
Mandible - The lower jaw.
Maxilla - The upper jaw.
Molar - Usually the largest teeth, near the rear of the mouth. Molars have large chewing surfaces.
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N
Neuromuscular Dentistry - Addresses more than the aches and pains felt in and around the neck and head that are associated with your teeth and jaw.

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O
Onlay - A filling designed to protect the chewing surface of a tooth.
Orthodontics - A field of dentistry that deals with tooth and jaw alignment.
Overdenture - A non-fixed dental appliance applied to a small number of natural teeth or implants.
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P
Palate - Roof of the mouth.
Partial denture - A removable appliance that replaces missing teeth.
Pediatric Dentistry - A field of dentistry that deals with children’s teeth
Perio pocket - An opening formed by receding gums.
Periodontal disease - Infection of the gum tissues. Also called gum disease.
Periodontist - A dentist who treats diseases of the gums.
Permanent teeth - The teeth that erupt after primary teeth. Also called adult teeth.
Plaque - A sticky, colorless substance that covers the teeth after sleep or periods between brushing.
Posterior teeth - The bicuspids and molars. Also called the back teeth.
Primary teeth - A person's first set of teeth. Also called baby teeth or temporary teeth.
Prophylaxis - The act of cleaning the teeth.
Prosthodontics - The field of dentistry that deals with artificial dental appliances.
Pulp - The inner tissues of the tooth containing blood, nerves and connective tissue.
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R
Receding gum - A condition in which the gums separate from the tooth, allowing bacteria and other substances to attack the tooth's enamel and surrounding bone.
Resin filling - An artificial filling used to restore teeth. Also called a composite filling.
Root canal - A procedure in which a tooth's nerve is removed and an inner canal cleansed and later filled.
Root planing - Scraping or cleansing of teeth to remove heavy buildup of tartar below the gum line.
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S
Sealant - A synthetic material placed on the tooth's surface that protects the enamel and chewing surfaces.
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T
TMJ - Temporomandibular joint disorder. Health problems related to the jaw joint just in front of the ear.
Tarter - A hardened substance (also called calculus) that sticks to the tooth’s surface.
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V
Veneer - A laminate applied or bonded to the tooth.
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W
Whitening - A process that employs special bleaching agents for restoring the color of teeth.
Wisdom tooth - Third set of molars that erupt last in adolescence.
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