How insurance works
Insurance has two major benefits for the patient: a discounted price on services (resulting in a lower out of pocket), as well as offering to cover a portion of the cost of services rendered. When we are in-network with your insurance provider, you are able to utilize the maximum benefits
The way our estimations work are based on your insurance's in-network discounted fees. So those are a fixed cost for you, but they can vary each year based on our negotiations with your provider, which may account for different quotes over a number of years. And every insurance company sets their own fees, so if you change insurance companies, the prices will change.
Your out-of-pocket responsibilities can vary according to your annual deductible, your annual maximum, and how much of that maximum you have left for the current plan year. This affects how much insurance will pay for your procedures. So, for example, if you have $100 left in your maximum and insurance would normally cover $200 for a procedure, then they would only pay the first $100 and you would be responsible for the $100 they didn't cover PLUS your normal out-of-pocket co-insurance.
If you have an HMO insurance plan they only cover certain services at a discounted rate and if the service is not covered by your insurance plan you are responsible for the regular price for that service. Because HMO insurance plans are highly discounted, your insurance may not help pay for some of the routine services that are part of the accepted standard of care.
How we can help you
Initial Verification: We want to make things as easy as possible for you to enjoy your trip to the dentist, so we try our best to understand your insurance coverage before your visit with us. We ask that you fill out your forms beforehand so that we can verify your insurance & benefits before your visit. This can help cut down on wait times when you arrive.
Approximately 48 hours before your appointment, we will use the online portals provided by your carrier or, if the information is unavailable, we’ll work our way through the automated system to speak to an insurance representative to understand the following:
1) Your annual maximums & deductibles
2) Your coverage percentages for Diagnostic & Preventive, Restorative, Periodontal, Endodontic, Oral Surgery, Crowns, and Orthodontic services
3) Allowable frequencies
We then apply your carrier's discounted fees to the treatment plan, which updates the total cost & estimated coverage percentages.
Claim Submission: After we submit claims to your insurance carrier, we work with them to provide more information, x-rays, and narratives to ensure the best possibility of pay-out. If we receive denials of coverage for services that weren't due to frequency, annual maximums, or non-covered services, we will send an appeal on your behalf to encourage their payout. We strive to get you as much coverage by your insurance as possible. But if your insurance company continues to deny our appeals, the balance on the account is the responsibility of the patient.
We ask that as soon as your updated insurance information is available, you pass it along to us so we can update your treatment fees (which affects your estimations). A phone call is the quickest way to get the information to us but feel free to email us the information as well. Ultimately, as the policy holder, you are responsible for understanding your coverage and limitations. As the person who pays them, insurance companies will often give you more thorough information then they give to us.
The following information is usually required to verify your insurance:
Subscriber's Date of Birth
Relationship to Subscriber
Member/Subscriber ID/SSN (For Metlife patients, your social security number is REQUIRED for the fastest verification)
Group # (if Known):
Cancelling & Rescheduling Appointments
To help us ensure all patients have access to treatment and appointments, we kindly require you offer at least 24-48 hours notice when cancelling or rescheduling your appointments.
Many insurance plans include a standard rate for missed appointments which will be added to your account if you do not provide adequate notice before your appointment time.
What if I don't have dental insurance?
We welcome patients without insurance. We offer flexible payment options and reduced fees for patients without dental insurance in order to help make dental treatment affordable. Please call our office for details.
Do you accept MediCal?
We currently do not accept MediCal. However, if you would still like to be a patient of ours, we would love to take care of your dental needs. You would be seen as a fee-for-service patient, as we cannot file claims to MediCal.