You can always contact your insurance company directly to learn about your coverage details and benefits. Alternatively, our team can assist you by obtaining a breakdown of your benefits. To do so, we'll need some information, including your carrier name and subscriber ID.

Being out of network means that our office does not have a direct contract with your insurance provider, but it does not mean we cannot accept your insurance. For those carriers with whom we have a direct contract, they offer in-network fees. When you are out of network, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to determine your out-of-pocket costs. We accept major PPO insurances. Please note, we are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

The fundamental concept of dental insurance parallels other employer-provided insurances like Medical and Vision. Typically provided through your employer, dental insurance involves monthly premiums and guidelines on preferred providers, with varying benefits. A notable distinction is that dental insurance sets a yearly maximum for reimbursement, while medical insurance covers costs beyond the individual's out-of-pocket maximum.

Dental insurance operates similarly to medical insurance, but with a key difference: the insurance provider covers up to a specified "maximum allowable" amount during a benefit period (often a year), after which the patient is responsible for any costs exceeding that limit. Knowing your plan's maximum allowable amount is crucial when considering more expensive treatments.

Similar to medical co-insurance, dental PPO plans typically categorize services into preventive, basic, and major, each with varying coverage percentages. For instance, many PPO plans cover preventive services at 100%, basic services at 80%, and major services at 50%. However, these specifics can vary by plan, so it's important to review your individual benefits to understand your coverage.

Any services not covered by your insurance are the patient's responsibility.

Dental insurance generally covers a wide range of dental services, including routine exams and cleanings (typically twice a year), basic dental procedures (such as fillings and crowns), as well as more complex treatments like oral surgery and orthodontics. These services are typically categorized into preventive, basic, and major categories, each with a predetermined coverage percentage. Common coverage breakdowns include 100% for preventive care, 80% for basic services, and 50% for major treatments.

Orthodontic treatments are handled differently and often involve specific age restrictions, eligibility criteria, and lifetime maximums rather than annual limits.

A PPO, or Preferred Provider Organization, allows you the flexibility to choose any dentist without requiring a primary dentist selection. You do not need referrals to see a specialist, though visiting an in-network specialist often results in cost savings. This contrasts with HMO/DHMO insurance plans, which usually offer dental services at a low cost or with minimal copayments, but require you to choose a primary dentist from a pre-selected network. Under HMO/DHMO plans, you are typically restricted to your chosen primary dentist unless referred to a specialist.

Typically, PPO plans cover two exams and cleanings per calendar year.

In most cases, yes. However, it's crucial to be aware of exceptions and rules before seeking care. For example, a dental implant may not be covered if your coverage includes a "missing tooth clause" and you were previously missing the tooth. We can assist you in obtaining information specific to your coverage rules.

In most cases, yes. Orthodontics have specific rules regarding age, eligibility within your plan, and the maximum coverage available. Typically, orthodontic coverage is governed by a lifetime maximum rather than an annual amount. We can assist you in obtaining information about the specific rules that apply to your coverage.