Feel free to contact your insurance provider to learn about your coverage details. Our team is also available to assist you in obtaining a breakdown of your benefits. Simply provide us with your carrier name and subscriber ID.

Our office may not have a direct contract with your insurance provider, but that doesn't mean we don't accept your insurance. For carriers we do have a contract with, we offer in-network fees. When out of network, we use the base price for the service and apply the coverage percentages that correspond to your out-of-network benefits to determine your out-of-pocket costs. We accept major PPO insurances, but we 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 by employers, dental insurance involves monthly premiums, provider restrictions, and varying benefits. One key distinction is that dental insurance has a yearly maximum reimbursement limit, while medical insurance covers costs after the individual reaches their out-of-pocket maximum.

Dental insurance operates similarly to medical insurance, but with the key distinction that the insurance provider covers up to a set maximum amount in a benefit period, while the patient is responsible for any costs exceeding that limit. It is important to be aware of your plan's maximum allowable amount when considering more expensive treatments. Dental PPO plans often categorize coverage into preventive, basic, and major services, with varying percentages covered for each category. For example, preventive services may be covered at 100%, basic services at 80%, and major services at 50%. It is crucial to review your specific plan details to understand your coverage. Any services not covered by your insurance will be the patient's responsibility.

Dental insurance usually includes coverage for a wide range of dental services, such as regular exams and cleanings (usually twice a year), basic procedures like fillings and crowns, as well as more complex treatments like oral surgery and orthodontics. These services are typically categorized as preventive, basic, and major, with each category covered at a specific percentage, leaving the patient responsible for the remaining balance (common coverage percentages are 100%/80%/50%). Orthodontic coverage is often subject to specific rules regarding age, covered individuals on the plan, and maximum benefits. Unlike other dental services, orthodontic coverage usually has a lifetime maximum benefit rather than an annual limit.

A PPO, or preferred provider organization, allows you to see any dentist without needing to choose a primary one. You can also see a specialist without a referral, but it's usually cheaper if they are in your plan's network. This is different from HMO/DHMO plans, which have low-cost dental services with minimal or no copayments, but require you to choose a primary dentist and only see specialists with a referral.

Typically, PPO plans provide coverage for two exams and cleanings per calendar year.

In general, dental implants are covered by insurance. However, there are exceptions and important rules to be aware of before receiving care. For example, if you were missing a tooth before getting coverage and your plan has a "missing tooth clause," a dental implant may not be covered. We can assist you in understanding the specific rules and coverage details for your plan.

Yes, in the majority of cases, orthodontic coverage has specific rules regarding age, eligible plan members, and coverage limits. Typically, there is a lifetime maximum amount rather than an annual limit. We can assist you in understanding the specific rules and coverage details for your plan.