Dental Insurance

Dental Insurance2018-08-08T19:23:24+00:00

Dental Insurance

Most Insurances are Accepted

As a service to our patients, our dental practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO in and out-of-network. Our PPO office is not part of any managed care network, like HMO, DHMO.

Regarding PPO dental plans, our administrative staff is well prepared to maximize your specific insurance benefits. We remind patients, however, that the specific insurance policy is an agreement between the patient and the PPO insurance company. PPO dental insurance helps dental treatments to be more affordable. Unlike most offices, we will allow you to pay your estimated co-pay upfront and as a courtesy to you, bill the insurance company for the remainder. Please keep in mind that you are responsible for your total obligation should your dental PPO insurance benefits result in less coverage than anticipated.

Our office accepts all PPO, DPPO and PDP insurances.  Although we still treat Medicare/Medicaid and HMO insurance holders, we are not able to accept HMO, Medicaid or Medicare programs through patient financing options.

  • Aetna PPO
  • Assurant PPO
  • Cigna PPO
  • Delta Dental Premier
  • Dentegra PPO
  • Guardian PPO
  • Lincoln Financial Group PPO
  • Metlife PPO
  • United Healthcare PPO

We accept Discount plans from: Dentex, Aetna Vital Savings/Aetna Dental Access, Cigna Dental Savings

  • United Concordia
  • UMR
  • Blue Cross Blue Shield
  • Humana
  • Ameritas
  • Aflac
  • Dental Select
  • DentaQuest
  • HealthSmart
  • HealthScope
  • LifeMap Assurance Company
  • Mutual of Omaha
  • Nipppon Life Insurance of America
  • Physician’s Mutual
  • Principal
  • Reliance Standard Life Insurance
  • Seafarers Welfare Plan
  • Simple
  • Sun Life Financial
  • T. M. L.
  • The Health Plan of the Upper Ohio
  • The Standard

.. and ALL OTHER PPO dental plans!

If you don’t see your insurance company listed and would like an immediate answer during office hours, please text us with the insurance company and type of policy, and we will gladly inform you quickly!

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. An insurance policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. Patients should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

Please note: We no longer accept DMO or DHMO dental insurance. We encourage you to switch over to your employer’s dental PPO or PDP plan to ensure that we can continue to offer the best dental care for you and your family.   

Office Policy

If we receive all of the necessary dental insurance information on the day of the appointment, we will be happy to file the claim for the patient. Patients must be familiar with their PPO dental insurance benefits, as we will collect from the patient the estimated amount PPO dental insurance is not expected to pay. By law, a PPO dental insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so the PPO dental insurance company will receive each claim within days of the treatment. The patient is responsible for any balance on the account after 30 days, whether insurance has paid or not.  

PLEASE UNDERSTAND that we file PPO dental insurance as a courtesy to our patients. We do not have a contract with any PPO insurance company. We are not responsible for how the insurance company handles its claims or for what benefits they pay on a claim. We can only assist the patient in estimating their portion of the cost of treatment. We at no time guarantee what the insurance provider will or will not do with each claim. We also cannot be responsible for any errors in filing insurance claims. Once again, we file claims as a courtesy to the patient.

Facts About Insurance Claims

 

Fact 1: NO INSURANCE PAYS 100% OF ALL PROCEDURES

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true. Most plans pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much the patient or the employer has paid for coverage or the type of contract the employer has set up with the insurance company.

FACT 2: BENEFITS ARE NOT DETERMINED BY OUR OFFICE

Patients may have noticed that sometimes their dental insurer reimburses them or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state the reimbursement was reduced because the dentist’s fee exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

PPO Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information for claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently this data can be three to five years old and these “ALLOWABLE” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that the dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low. In general, the less expensive insurance policy will typically use a lower, customary, or reasonable (UCR) figure.

FACT 3: DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED

When estimating dental benefits, deductibles and percentages must be considered. MOST IMPORTANTLY, please keep the dental office informed of any insurance changes such as policy name, insurance company address, or change of employment.

FINANCIAL AGREEMENT

Payment for dental services is to be paid in full at the time of service. Artaza Dental accepts cash, check, Master Card, Visa, American Express, Discover and Care Credit. Returned checks are subject to a processing fee as determined by the Bank and the office. PLEASE BE AWARE THAT THE PERSON OR PARENT BRINGING THE PATIENT TO OUR OFFICE AT THE TIME OF SERVICE IS RESPONSIBLE FOR PAYMENT OF ALL CHARGES. If someone other than the parent accompanies the patient, arrangements for payment should be planned in advance.

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