Dental Insurance FAQs

Do you accept my dental insurance?

If you have a PPO dental plan, then yes! We’re an out-of-network dental office and PPO plans give you the freedom to stay in network or go out of network. HMO plans do not offer this flexibility, so you must choose a dentist from within your insurer’s exclusive network.

What’s the difference between in-network vs. out-of-network dentists?

In-network dental offices have contracts with insurance companies. They must follow treatment limits and set fees, even if the fees are low. Out-of-network dental offices, like ours, do not have these contracts. This lets us have more control over the quality of your care.

Why are you out of network?

We firmly believe in a higher standard of care, without compromise. By choosing to be out of network, we can spend more time with you. We can treat you with the quality of care you deserve – free of restrictions placed by your insurer. When insurance companies limit our methods or approaches to best treat you, and the quality of materials we use, it’s simply not okay with us. We believe you should decide on the care you receive, not your insurer.

Will my dental insurance benefits differ if I go out of network?

Most likely, yes. However, it’s not a hard and fast rule. Some insurance plans offer the same benefits for out-of-network dentists as they do for in-network ones. And, most plans give you a side-by-side column view of the differences.

Patients who go out of network enjoy the freedom to choose who they want to see, advanced technologies and materials, and more personalized care.

Before you book an appointment with us, please check the details of your PPO plan, especially your out-of-network benefits. If you still have questions, the best way to get answers about your coverage is through your insurer. Knowing what your plan covers before you see us helps avoid any confusion later on.

Will you tell me what your fees are beforehand?

We value your trust above all else and are completely transparent about our fees. Our treatment plan for you includes all fees in detail. What we cannot tell you definitively is what your plan covers. For this, we can request a pre-treatment authorization from your insurer – this gives you a clear view of your coverage and your ultimate co-pay. Please keep in mind that our final fee could change. This only happens if we find anything needing immediate attention or extra work during a procedure.

When do I have to pay for your services?

If you have a Delta Dental PPO plan, we collect our fees from you at the end of your visit and submit your claim. After Delta receives your claim, they will reimburse you the appropriate amount directly.

For all other PPO plans, we submit your claim and accept payment from your insurer. If you have a remaining co-pay, we will send you a statement with a request to pay within 15 days.

We accept major credit cards, debit cards, cash, and personal checks. Also, you can make a secure payment with Apple Pay, Google Wallet, PayPal or Venmo.

How quickly will you file my dental insurance claims for me?

We typically file your claim the same day as your visit. Therefore, you should receive payment from your insurer within 15 to 60 days. Your coverage is an agreement between you and them, while our office helps by processing the paperwork. If you have reimbursement or benefit questions, please call your insurer directly.

Do you offer dental savings plans and financing options?

Yes. If you don’t have insurance, please check out our very own SmileWise dental savings plans. Our office designed these plans to help you save money and keep you on track with your oral health.

If financing options are of interest to you, no- to low-interest payment plans from CareCredit or Cherry may be good options for you. For more information, visit our page about Payment Options.

Can you summarize what dental insurance is and how it works?

Sure. In the spirit of keeping it simple, here are some basic but important things to know:

Dental insurance helps cover the costs of dental care

If you have a dental plan, you and your insurer share the costs. The percentages vary on the type of services such as preventative, basic, and major care. Your insurer predetermines what those coverage percentages are including what they will and will not cover. To maintain your coverage, you pay them a monthly premium.

Having dental insurance is not a requirement

In fact, some people who have excellent oral hygiene and get routine X-rays, exams, and cleanings elect not to buy it. They find that paying for dental services themselves makes more sense. The cost of monthly premiums plus their out-of-pocket share is often roughly the same or even less.

The quality of dental insurance policies vary quite a bit

You’ll find excellent, fair, and poor ones out there. What your policy covers is based on how much you pay for it. Generally, the more you pay for your premium, the better your coverage. Likewise, the less you pay for your premium, the higher your out-of-pocket costs.

Dental HMO and PPO plans offer different approaches to dental insurance

With a dental HMO plan, you must choose a dentist within your plan’s network. It does not cover care outside of the network. Typically, you need a referral to see a specialist within the network.

A dental PPO plan offers you more flexibility. You can choose from a wider selection of dentists and specialists, including those outside of your plan’s network. Typically, you can see a specialist without a referral from your dentist.

Both HMO and PPO plans use a set list of “allowable” fees to determine what they will pay. These fees (also known as negotiated rates or fee schedules) might be lower than our usual fees. This means that even if your preventative care is covered 100%, you may still owe a balance. Be sure to review your plan details carefully.

Also, both types of plans have a unique set of exclusions, limitations, and waiting periods that vary depending on the specific policy.

Looking for a more complete summary about dental insurance?

We think this two-page Consumer’s Guide to Dental Benefits by the California Dental Association (CDA) is a great resource.

I have specific questions about my unique situation, can I call you?

Most certainly – we’re accessible and happy to help in any way we can. Just call, email, or text us!