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INSURANCE


As a courtesy to all of our patients, we accept all PPO based plans and electronically submit claims to your insurance on your behalf. Insurance can be confusing for everyone (even us!). All plans are very different in their coverage amounts, maximums, limitations, etc. We do our best to contact your insurance carrier with the information you provide to us to ensure your eligibility prior to your appointment so there are no surprises (i.e. no coverage, a large copay, etc.). Please be prepared to give us the following information when you call to schedule your initial visit: subscriber's name, date of birth, insurance carrier, member ID or social security number. For completeness of records when filing a claim, please also have the subscriber's address and employer if it is different from your own. If the information is not readily available when you call to make your appointment, we ask that you provide it to our staff at least 3 business days in advance to give us the opportunity to verify it for you. Alternatively, all this information is also requested on our online new patient forms. If you plan on filling out the paperwork online prior to your appointment, there is no need to give us the above information when scheduling an appointment, as long as your paperwork is filled out 3 business days in advance.

 

If shopping for an insurance plan, a few things to look out for:

  • PPO: this means that you can CHOOSE your provider. HMO/DHMO/DMO plans only allow you to go to certain offices that accept these plans. These tend to be the larger "chains." While they may seem more affordable at the time, the coverage is typically not better and you may end up seeing miscellaneous charges on your bills to make up for the coverage amounts.

  • No Waiting Periods: Some insurances companies have waiting periods for treatment. This means that in the event you need a filling, they may say that the insurance policy must be in place for 6 months or a year before they will provide coverage. The same applies to crowns or what they consider "major" treatment. Basically, waiting periods are bad for you.

  • No Missing Tooth Clauses: Getting insurance because you lost a tooth at some point in your life and you want to replace it? Well make sure that the plan you choose does not have a "missing tooth clause". What this means is that if the tooth was missing or extracted prior to coverage with this plan, they will not cover any of the expense to replace it. Bummer, we know.

 

 

In-Network vs. Out-of-Network

In-network means that we are contracted with your insurance company to discount our fees for their policy holders. Anywhere you choose to go, the fees for your in-network providers will be the same. The difference comes if we are an out-of-network provider. The way that works is that the insurance pays what their maximum allowable amount and if the provider's fees are higher, you are responsible for the difference.

 

We are in-network with many carriers through Connection Dental and then individually contracted with some other carriers. This list includes, but is not limited to: Aetna, Assurant, Cigna, Erisa, Humana, Guardian, Delta Dental, Metlife, Sunlife, United Healthcare... and the list goes on. However, certain carriers have set their fees so low that we cannot provide the quality of care that you deserve while still covering our operational costs. We refuse to compromise our care for you based on insurance because we think you deserve better. If you have issues with the plan that was chosen by your employer, we urge you to contact your HR department.

 

You can call your insurance company or often time, check their website to verify if we are in-network. Either way, we accept all PPO insurances and process claims on your behalf. If we are out-of-network, we can assure you that we are worth it and so is your health.