832-757-1009
ACCEPTED PLANS
We've Got You Covered
All Aetna Plans
All BCBS Plans
Careington
Cigna
All Guardian Plans
All Humana Plans
All Metlife Plans
(except PDP*)
Sun Life/ DHA Plans
United Concordia
United Health Care
All Delta Dental Plans*
Ameritas*
Principle*
*For these plans, we will help MAXIMIZE your benefits and MINIMIZE your out of pocket expense.
If you don't see your plan on this list, please call our office to inquire about your specific plan.
After your visit, some patients may receive an email from your insurance provider suggesting visiting a different dentist. This is a common tactic insurance companies use to reduce the portion they pay toward your treatment. We understand these emails can be misleading and confusing, but rest assured, we’re here to help. If you receive such a message, don't worry and let us know right away. We’re happy to provide a full breakdown of your out-of-pocket costs and ensure you’re maximizing your benefits.
Understanding Your Dental Insurance
Dental insurance can sometimes feel overwhelming, but we’re here to help make it simple. We have put together a guide to knowing how dental insurance works.
*This guide does not include all the terms and conditions of each individual insurance provider. Please call your insurance provider for more details.
How Dental Insurance Works:
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Dental insurance often comes with an annual benefit limit, typically ranging from $1,500 to $2,000.
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We find that individuals who require less than $1,500 in dental treatment each year benefit the most from traditional dental insurance.
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For those with greater dental care needs, our in-house membership plan offers more comprehensive value and savings, making it the better choice for achieving optimal oral health.
Dental PPO Basics:
Dental plans often follow a 100-80-50 model where:
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Preventive care is covered 100%
-Regular cleaning, Some X-rays, Most Exams,
Sealants, and Fluoride
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Basic procedures are covered 80 %
- Fillings (1-4 surfaces on any teeth once per year)
- Deep cleaning (only covered once per 2 years)
- Diagnostic (non-routine) x-rays
- Simple (non-impacted) extraction
- Emergency care for tooth/gum pain
- Root canals (usually basic, but sometimes major)
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Major procedures are covered 50%
- Crowns (Limitation on type of material)
- Surgical Extractions (Does not cover bone graft)
- Root canals (limitation if done with a specialist)
- Inlay and Onlay
- Some will cover implants
Copay's and deductibles
- A co-pay is the amount you pay at the time of your dental service which is the 'patient portion' of the treatment. It’s a shared cost between you and your insurance provider.
Example: If your filling costs $100 and your insurance covers 80% of the cost, than your copay would be $20 (the amount not covered by your insurance).
- A deductible is the amount you must pay out-of- pocket for dental services before your insurance starts covering a portion of the costs.
Example: If your deductible is $50 and your treatment costs $200, you’ll pay the first $50, and your insurance will help cover the remaining $150 based on your coverage level (e.g., 80% for fillings) making your out of pocket $50 (deductible) + $30 (copay).
How is medical insurance different from dental insurance
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Medical insurance does not have the three tiers (100-80-50) like dental insurance and it is designed to prevent financial ruin due to unexpected or severe health issues.
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Medical plans typically have deductibles (amounts you must pay before insurance kicks in) and may have out-of-pocket maximums to protect against catastrophic costs.
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This means once you reach the maximum limit, the insurance covers 100% of additional costs and your out of pocket it $0 beyond the maximum limit. THIS IS THE OPPOSITE OF DENTAL INSURANCE.
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With dental insurance, once you reach your maximum benefits, members cover the cost of the remaining treatment 100% out of pocket and the cost is no longer shared by your insurance.
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Understanding your insurance policy is essential, and we’re here to help you navigate the process. While we strive to provide guidance, it is ultimately the insured member's responsibility to be familiar with their coverage details. Any costs not covered by your insurance will be your responsibility.
How dental insurance has changed in the last 20 years:
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The cost of dental treatment has increased at a rate of 3% annually (to match yearly inflation), but the annual maximums set by insurance companies have not changed in the last 2 decades!
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The reimbursements given to patients have either stayed the same or decreased in the last 20 years!
How does this effect you?
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This means patients will reach their maximums quickly WITH FEWER treatments compared to those in the past.
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There is less coverage than ever before at the cost of the patient’s well being.
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Most insurance will dictate treatment coverage by setting unrealistic guidelines. The people making these rules and decisions are not dentists and their goal is to pay the least amount possible towards your benefits. This makes it difficult for both the office and the patient. When this happens you need to choose if you will let your insurance determine what treatment is best for you OR your doctor who took an oath to do no harm and who cares about your well being.
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If your insurance does not cover their contracted portion for the treatment rendered, then you are responsible for 100% of the treatment cost.
Your EMPLOYER and the HR department are responsible for choosing your insurance. If you would like a different option, speak to your EMPLOYER/HR department (sometimes this helps).
What questions to ask when looking for dental insurance
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Is there a waiting period and how long?
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Do I have a deductible and how much?
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What is my Annual maximum?
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Once I reach my annual max, do I pay 100% of the office fee’s or 100% of the contracted fee’s?
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If I have a discount plan (not traditional insurance) can I still benefit from the office membership plan?
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What procedures are considered Basic vs Major?
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What is my basic covered benefit for crowns and fillings? (This will tell you the material which is covered)
- Sometimes, they do not cover zirconia or
ceramic materials which are the best
materials for crowns on the market today.
- OR they will downgrade and the patient is
responsible for the difference.
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Which materials and treatments are downgraded? Who is responsible for the difference?
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Are night-guards a covered benefit?
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Is in office whitening a covered benefit?
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Are metal braces or clear aligners a covered benefit?
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Is there specialty treatment coverage?
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Are implants a covered benefit?
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Is sedation a covered benefit?
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Is there a missing tooth clause and what does that mean?
- if the tooth is missing before you obtained insurance, then the insurance will not cover the cost to replace that tooth or will downgrade to a removable partial denture vs an implant or bridge to replace the missing teeth/tooth.
*This guide does not include all the terms and conditions of each individual insurance provider. Please call your insurance provider for more details. We hope this guide was helpful.
A Few Things to Keep in Mind
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Our treatment recommendations are tailored to your unique dental needs and goals, not dictated by the limitations of any insurance plan.
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We focus on treating you as an individual, not your insurance policy.
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Together, we’ll create a treatment plan that prioritizes your health and aligns with your best interests.
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Your insurance benefits are determined by the terms of the agreement between your employer and the insurance company.
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Many PPO plans provide benefits even if you choose an out-of-network dentist.
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Dental insurance is designed to assist with the cost of care, not to cover it entirely. It’s a tool to reduce out-of-pocket expenses, not a comprehensive payment plan.
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Our office is not part of the legal agreement between you and your insurance provider and cannot be held responsible for their policies or decisions.
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While we strive to provide accurate diagnoses and treatment plans, unforeseen circumstances can arise, particularly with complex cases. We do our best to estimate as closely as possible, but adjustments may be needed.
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