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Insurance
We welcome most dental insurance plans and can bill services through insurance. If you do not have insurance, inquire about our TranscenDental Smiles Membership.
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Frequently asked questions
Feel free to reach out to your insurance provider to clarify your coverage, and we are also here to help! Simply provide us with your carrier name and subscriber ID, and one of our team members will gather a comprehensive overview of your benefits.
Our office can still accept your insurance even if we are out-of-network with your provider. For in-network carriers, in-network fees will apply. 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 calculate your payment. We accept major PPO insurances, but we are not contracted with Denti-Cal, Medi-Cal, or HMO plans.
Dental insurance, like Medical and Vision insurance, is a fundamental concept that is typically provided by employers. It includes monthly premiums, guidelines on preferred providers, and benefits. One key difference is that dental insurance has a yearly maximum for reimbursement, while medical insurance covers reimbursement after an individual reaches their out-of-pocket maximum.
Dental insurance is similar to medical insurance, but with a key difference: the insurance provider covers up to a maximum allowable amount in a benefit period (usually a year), and the patient is responsible for any costs that go beyond that limit. It's important to know your plan's maximum allowable amount when considering pricier treatments. Dental PPO plans, like medical co-insurance, often cover services in different categories: preventive, basic, and major. For example, many PPO plans fully cover preventive services, provide 80% coverage for basic services, and 50% coverage for major services. However, coverage details can vary by plan, so it's important to review your benefits to understand your coverage. Patients are responsible for any costs not covered by insurance.
Dental insurance usually covers a range of dental services such as exams, cleanings (usually twice a year), basic procedures like fillings and crowns, as well as oral surgery and orthodontics. These services are divided into preventive, basic, and major categories, with coverage at a set percentage and the patient responsible for the rest. Orthodontic coverage may have age restrictions, limitations on beneficiaries, and lifetime maximums instead of annual limits.
A PPO, or "preferred provider organization," allows you to choose your own dentist without having to designate a primary one. You can see specialists without needing a referral, but you may save money by staying within the network. On the other hand, HMO/DHMO plans offer low or no copayments for dental services but require you to choose a primary dentist and only allow you to see other providers if referred by them.
Typically, PPO plans provide coverage for two exams and cleanings per calendar year.
Dental implants are often covered by insurance, but it's important to be aware of any exceptions and rules before moving forward with treatment. For instance, if your insurance has a "missing tooth clause," a dental implant may not be covered, especially if the tooth was missing before. We can help you understand the specific rules and coverage that apply to your situation.
In most cases, yes. However, orthodontic coverage may have age restrictions, limitations on who can be covered, and a lifetime maximum instead of an annual limit. We can help you find out the details of your plan's rules and coverage.
