Every smile is beautiful! meaningful! wonderful!
EVERY SMILE COUNTS!
EVERY SMILE COUNTS!
We accept and honor most dental insurance plans. The following are just a few of the dental insurance carriers we’re providers for :
Even if we are not in your network, we are more than willing to file a claim with your insurance provider. We truly want our patients to get the most from their insurance benefits and will gladly do what we can to help you.
Please call our office for more details at: 310-326-3657
What is dental insurance?
Maintaining good oral health and preventing dental problems before they happen are important to staying healthy. Dental insurance helps you manage the cost of dental care so you can maintain your overall good health. Most dental insurance covers preventive care, which includes regular checkups by your dentist, and may also cover care for cavities, implants or getting a tooth knocked out.
How does dental insurance work?
Dental insurance works a lot like health insurance. Each month you pay a premium (a set dollar amount) and when you visit the dentist, you may be responsible to pay a co-pay, if your plan includes co-pays. The dentist’s office will bill the insurance company directly for your care. Most preventive care visits, which often cover checkups and cleanings, are covered under your dental insurance plan. Your insurance company will pay the dentist directly for your preventive care visits while you are only responsible for your co-pay, if your plan includes co-pays.
If you have a dental procedure that is not considered preventive care, the dentist’s office will send your insurance company a bill and, depending on your plan, your dental provider will bill you for the portion of the procedure your insurance company did not cover. You can find which procedures are covered by reviewing your plan details.
What’s a covered benefit?
Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group’s plan.
What is a PPO dental plan?
Dental insurance from a preferred provider organization (PPO) means that you can choose any dentist, in- or out-of-network, and you don’t need a referral. You also have the flexibility to visit dentists and specialists outside of your network, but at a higher cost.
What is Indemnity Dental Insurance?
With this type of plan, you have the freedom to visit any dentist. The providers of indemnity dental insurance (also known as “carriers”) only make pay for work after they receive and review the dentist’s bill. Those who subscribe to this type of plan (members or patients) must pay for work in full and then submit a claim to the carrier to be repaid. The payments may be made to the plan member or to the dentist. Thus, those with indemnity plans pay more out of pocket. On the other hand, compared to managed care plans, they have a broader choice of dentists to work with.
What is a Discount Dental Plan?
Discount dental plans (DDPs) or “discount dental cards” are not insurance. However, they help consumers save on dental care costs. Members make monthly or annual payments and may receive unlimited dental care services at discount prices based on a fee schedule. Services are provided by dentists who participate in the plan’s dental network.
What is a DHMO?
Dental insurance from a Health Maintenance Organization (HMO) comes at a lower cost, but does not cover all procedures and requires that you only visit dentists and specialists that are in-network. Dental HMO plans also commonly include co-pays.
Does dental insurance cover braces?
Today, kids and adults both need braces. If you or a family member needs orthodontic care, or will need it in the future, it’s smart to look for a dental insurance plan with orthodontic benefits in order to manage those costs. Different dental insurance plans offer different discounts on the cost of braces and other devices, so be sure to read carefully through the benefits offered in each plan.
Orthodontic care may not be covered if you begin treatment before you start a dental insurance plan. Be sure to get dental coverage before you start working with an orthodontist.
My dentist recommends a ceramic crown, but my dental benefit will only pay for a large filling, which treatment should I have?
Some plans will only provide the level of benefit allowed for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist as to the best treatment. Sometimes, special circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alter its coverage. As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit plan.
My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment really isn’t necessary?
Exactly what is dental insurance for Individuals?
Dental plan coverage for individuals is not commonly offered because dental needs are highly predictable. For example, you would not pay premiums for your dental coverage if the premiums were more expensive than the cost of the dental treatment you need. Since this is the case, insurance companies would stand to lose money (spend more on benefits than they receive in premiums) on every individual dental plan they write.
There are, however, a few companies that offer a form of dental benefits for individuals. Most of these plans are “referral plans” or “buyers’ clubs.” Under these types of plans, an individual pays a monthly fee to a third party in return for access to a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist. The third party acts only in the capacity of matching the individual to the dentist. The dentist receives no payment from the third party other than in the form of referral of patients.
How are benefits determined?
You should know how your plan is designed, since this can affect significantly the plan’s coverage and your out-of-pocket expense.
Some employers now offer more than one dental plan to their employees. In fact, the right to choose between two plans could be the law in your state. To understand and make decisions about your dental benefits, it is important to remember that plans are often very different. To make the best decision for you and your family, you should understand exactly how the different kinds of dental benefit plans work and how they derive their cost savings.
There are many ways to design a dental benefits plan. Although the individual features of plans may differ somewhat, the most common designs can be grouped into the following categories:
Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice.
“Usual, Customary and Reasonable” (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist’s fee or the plan administrator’s “reasonable” or “customary” fee limit—whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called “customary,” they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the “customary” fee level.
Table or Schedule of Allowance programs determine a list of covered services with an assigned dollar amount. That dollar amount represents just how much the plan will pay for those services that are covered. Most often, it does not represent the dentist’s full charge for those services. The patient pays the difference.
Preferred Provider Organization (PPO) programs are plans under which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. If the patient’s dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits.
Capitation programs pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient co-payment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient’s actual dental care.