Insurance Information

Please contact your insurance provider for information on your coverage and costs. If you need assistance, our team is here to help. Provide us with your carrier name and subscriber ID, and we can assist you in understanding your benefits.

If we are out-of-network with your insurance provider, it means we don't have a direct contract with them, but we still accept your insurance. For carriers with whom we have a direct contract, we offer in-network fees. When you are out-of-network, we use the base price for the service and apply the coverage percentages according to your out-of-network benefits to determine your responsibility. We accept major PPO insurances but are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

Dental insurance functions similarly to other employer-provided insurances such as Medical and Vision. Typically provided through employers, it entails monthly premiums, preferred providers, and benefits guidelines. One key difference is that dental insurance imposes an annual maximum reimbursement limit, whereas medical insurance starts covering expenses once an individual reaches their out-of-pocket maximum.

Dental insurance operates similarly to medical insurance, but with a significant distinction: the insurance provider covers up to a predetermined amount within a benefit period, typically a year. Costs exceeding this limit become the responsibility of the patient. The maximum allowable amount varies based on your insurance plan and is crucial to consider when contemplating expensive treatments. Dental PPO plans classify services into preventive, basic, and major categories, each with its own coverage percentage. For instance, many PPO plans cover 100% of preventive services, 80% of basic services, and 50% of major services. However, these percentages vary by plan, underscoring the importance of understanding your coverage through a review of your personal benefits. Any expenses not covered by insurance must be paid by the patient.

Dental insurance generally covers various dental procedures including exams, cleanings, fillings, crowns, oral surgery, and orthodontics. These services are classified as preventive, basic, and major, with predetermined coverage percentages, and the patient is responsible for any remaining costs. Orthodontic coverage differs, often with age restrictions, limitations on beneficiaries, and lifetime maximums rather than annual limits.

A PPO, or "preferred provider organization," permits you to select your own dentist without requiring a primary dentist. You have the flexibility to visit specialists without a referral, although opting for in-network providers can lead to cost savings. In contrast, HMO/DHMO plans prioritize affordable dental care, often with minimal to no copays, through a designated primary dentist or facility. Under HMO/DHMO plans, you are typically required to choose a primary dentist and may only visit specialists with a referral.

Typically, PPO plans provide coverage for two exams and cleanings per calendar year.

In many cases, yes. However, it's crucial to understand any exceptions and regulations beforehand. For instance, dental implant coverage may be affected by factors like a "missing tooth clause" in your insurance plan, especially if the tooth was missing before. We can help you gather information about the specific rules that apply to your coverage.

While orthodontic treatment, including options like Invisalign, is often covered by dental insurance, it is subject to specific regulations. These may include age eligibility, covered beneficiaries, and maximum benefit amounts. Orthodontic coverage usually involves a lifetime maximum rather than an annual limit. We can help you understand the specific rules that pertain to your coverage.