Insurance Information

Feel free to reach out to your insurance provider to learn about your coverage details and any associated costs. If you need assistance, our team is here to help! Simply provide us with your carrier name and subscriber ID, and we can obtain a breakdown of your benefits for you.

Being out of network means our office doesn't have a direct contract with your insurance provider; however, it doesn't imply that we don't accept your insurance. For carriers with whom we have a direct contract, they offer in-network fees. When out of network, we utilize the base price for the service and apply the coverage percentages corresponding 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 operates on a similar principle to other employer-provided insurances like Medical and Vision. Typically offered through employers, dental insurance involves monthly premiums and guidelines regarding preferred providers and benefits. However, a key distinction lies in the fact that dental insurance providers set a yearly maximum reimbursement limit, whereas medical insurance kicks in after an individual reaches their out-of-pocket maximum.

Dental insurance operates similarly to medical insurance, but with a key distinction: the insurance provider covers up to a "maximum allowable" amount within a benefit period (usually a year), leaving the patient responsible for any costs exceeding that limit. The maximum allowable amount varies based on your insurance plan and is crucial information when considering more expensive treatments. Additionally, similar to medical co-insurance, dental PPO plans typically categorize services into preventive, basic, and major, each with its own coverage percentage. For instance, many PPO plans offer 100% coverage for preventive services, 80% for basic services, and 50% for major services. However, these percentages are plan-specific, and understanding your coverage requires consulting your personal benefits. Any costs not covered by your insurance are the patient's responsibility.

Usually, dental insurance encompasses various dental procedures, including exams, cleanings (often twice a year), basic treatments like fillings and crowns, as well as oral surgery and orthodontics. Insurance plans classify these services into preventive, basic, and major categories, each covered at a predetermined percentage, with the patient responsible for the remainder. Common coverage breakdowns include percentages like 100%/80%/50%. Orthodontic coverage is distinct, typically governed by age restrictions, limitations on plan beneficiaries, and specified coverage limits. Unlike other dental services, orthodontic coverage often entails a lifetime maximum rather than an annual limit.

A PPO, or "preferred provider organization," offers flexibility in selecting a dentist as it doesn't mandate a primary dentist. Referrals to specialists are unnecessary, though seeking care within the network often results in cost savings. This differs from HMO/DHMO plans, which prioritize low-cost dental services with minimal or no copayments through a designated primary care dentist or a dental facility. With HMO/DHMO plans, selecting a primary dentist is compulsory, and patients are generally limited to this choice unless referred to a specialist.

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

In many instances, yes. Nevertheless, it's essential to be aware of any exceptions and regulations before seeking care. For example, a dental implant might not be covered if your insurance plan includes a "missing tooth clause" and you were previously missing the tooth. We can assist you in obtaining information regarding the specific rules applicable to your coverage.

In many cases, yes. However, orthodontic treatment is distinctive and often subject to regulations concerning age eligibility, covered beneficiaries, and maximum benefit amounts. Typically, orthodontic coverage entails a lifetime maximum rather than an annual limit. We can assist you in obtaining information about the specific rules that apply to your coverage.