Insurance FAQ's

Yes! Our office accepts most major dental insurance plans. Because there are hundreds of plans and plan variations, we recommend contacting our office with your insurance information so we can help verify your benefits, or contacting your insurance directly. We do not accept Medicaid or Tristate plans.

Yes. Patients with Blue Cross Blue Shield dental plans are welcome at our office.

While we may be considered out-of-network for BCBS dental plans, many of these plans still allow you to receive care at any dentist you choose. In these cases, we submit the claim for you, and your insurance company may send the reimbursement payment directly to you according to your plan’s out-of-network policy.

When a dentist is an in-network provider, they have agreed to the insurance companies set pricing (known as a fee schedule) billing rules, and reimbursement terms. This is a contracted partnership that the doctor agrees to treat the plans members under the terms the insurance company sets.

For example, if your provider is in network with BrightSmiles Dental Plan, BrightSmiles dental can dictate what the provider is allowed to charge, based on their usual and customary fees (UCR). If your provider bills the plan $123.00 for an exam, but BrightSmiles Dental only allows $90, they will cover $90 as “100%” of their fee and because the provider is contacted, they will agree to waive the remaining portion.

When seeing an out of network provider for this same scenario, the patient would be responsible for the remaining $33.00.

Plans can vary greatly with these payments as some insurances will pay as low as .70c for an exam, while others may cover the providers full fees. In some cases, a patient’s plan may require them to see an in-network provider only, which is why it is very important to understand your benefits. This information is typically only provided to the subscriber, and is generally not something that we can determine.

Yes. As a courtesy to our patients, we submit insurance claims on your behalf. Our team works directly with your insurance company to help ensure your claim is processed correctly.

Although we verify your benefits and submit claims, it is ultimately up to the patient to know the difference between their Medical and Dental insurance, and the specifics of their policy. You will be expected to pay for services rendered if the office is unable to verify your insurance information prior to treatment, and any information should be provided in advance.

If a claim is denied and we believe it may qualify for reconsideration, our team will gladly submit up to two appeals on your behalf when appropriate.
Although we are happy to advocate for our patients with insurance companies, final coverage decisions are made by the insurance provider. If the claim continues to be denied after the appeals process, the remaining balance will become the patient’s responsibility.

Patients are responsible for their estimated portion at the time of service. This may include deductibles, co-payments, or procedures not fully covered by insurance. If you are unsure what your copay may be, please give our team a call and we will do our best to provide you an estimated copay. It is important to note that all pre-treatment estimates are good for 60-90 days. Coverage can change sooner if the plan year resets, annual maximums are used elsewhere or if the patient changes employers or plans.

A deductible is the amount you must pay out of pocket before your insurance begins covering certain services. Many plans waive the deductible for preventive care such as cleanings and exams.

The annual maximum is the total amount your insurance plan will pay toward dental care in a benefit year. Once that limit is reached, additional treatment costs become the patient’s responsibility until the plan resets.

No problem! Many of our patients do not have insurance. Our office offers affordable payment options and provides an in-office membership or savings plan to help make dental care accessible.

For patient convenience, we accept multiple forms of payment including cash, personal check, Visa, Mastercard, HSA and Care Credit.