Insurance Frequently Asked Questions

Common questions about insurance

Do you have questions about dental insurance? Here are some of the most commonly asked questions we hear. If your question isn’t on the list, please reach out to us and we would be happy to assist you!

Dental insurance works by contracting a dentist to accept a fee schedule, and based on the fee schedule, the patient pays a percentage. For a few preventative procedures (exam, x-rays, and the most basic cleaning) the patient may not have a copay.

We accept all PPO insurance plans as an out-of-network provider. We will file the patient’s claim on their behalf and make sure the check is written in their name.

An in-network provider is one that has agreed to accept the insurance company’s insurance reimbursement fees under the contract. An out-of-network provider is not obligated to follow the insurance fee schedule.

This varies greatly between insurance companies, and those companies offer many different plans that your employer chooses on your behalf. So, it’s impossible to know without understanding exactly which plan the individual has.

This will depend on the specifics of your plan. Some don’t have waiting periods. Some do. The waiting periods can range from 6 months to 2 years, and vary based on the procedure.

We welcome any patient without dental insurance.

As a general rule, implant placement is not covered by insurance, but there may be coverage for the crown (tooth) that is placed on the implant later.

Yearly maximums and frequency clauses (how often a procedure can be done in a specified period of time) can make dental insurance feel restrictive and/or a poor value.

Teeth whitening is not usually covered by insurance.

Most PPO plans have yearly maximums, which means that beyond a certain dollar amount used in a calendar year, the plan will cease to reimburse the patient, even if it’s a covered service.

There are options to get dental coverage through Medicare, but we will not file any claims with Medicare.

The best way to save money on dental expenses is to see your dentist regularly and make thorough dental hygiene practices a daily habit.

Generally speaking, dental insurance is focused on providing coverage for the patient’s needs. Those things that the patient wants (cosmetic enhancement) are typically not covered by insurance.