Insurance Information

If your insurance provider is out of network, our office may not have a direct contract with them. However, we still accept your insurance and offer in-network fees for carriers we have a direct contract with. When you are out of network, we use 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 similarly to other employer-provided insurances like Medical and Vision. Typically offered through employers, it includes monthly premiums, preferred providers, and benefits. One notable distinction is that dental insurance has an annual maximum reimbursement limit, whereas medical insurance begins covering costs once an individual reaches their out-of-pocket maximum.

Dental insurance works similarly to medical insurance, but with a key distinction: the insurance provider will cover costs up to a certain amount within a benefit period, typically a year. Any expenses exceeding this limit are the responsibility of the patient. The maximum allowable amount varies based on your specific insurance plan and is crucial to be aware of when considering 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 are unique to each plan, so it is essential to understand your coverage by reviewing your individual benefits. Any costs not covered by insurance must be paid by the patient.

Dental insurance typically includes coverage for a variety of dental procedures, such as exams, cleanings (usually twice a year), basic treatments like fillings and crowns, as well as oral surgery and orthodontics. These services are usually divided into preventive, basic, and major categories, with each category covered at a specific percentage, leaving the patient responsible for the remaining costs. Common coverage breakdowns may include percentages like 100%/80%/50%. Orthodontic coverage differs from other dental services, with age restrictions, limitations on beneficiaries, and specific coverage limits. Orthodontic coverage often has a lifetime maximum instead of an annual limit.