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Insurance Companies

While we accept most plans, please note that the some plans are not accepted by the Dentist.  We will verify insurance participation as well as checking eligibility, plan benefits, co-pays, deductibles, and limitations.

Please review orthodontic benefits and plan limitations with your Insurance Company, as each benefit and individual allowance varies per your employers contract.  Most plans only include the band placement and 24 monthly visits ONLY.  Most often when treatment requires additional appliances or extended treatment, these fees will be incurred by member.  Generally, our office allows a 3 month courtesy adjustment period, however, per our contractual agreement with the insurance, each additional visit, i.e., for broken brace,  wire replacement etc., will be billed as a separate visit.     

Insurance is not a guarantee of payment, and the member must maintain active coverage during the entire course of treatment.  Should there be a change and or termination of insurance during the course of treatment, so will the fee agreement change.

What's Covered by Dental Insurance?

If you have dental insurance, familiarize yourself with your plan so you know what is covered and how. For example, if you require a dental filling and would prefer a composite material, evaluate the benefits allocated in your plan for composite fillings. Many insurance companies will only reimburse composite filling costs at a rate equal to that of an amalgam filling. You would be required to pay the remaining balance as an out-of-pocket expense.

Plans have limitations on the number of dental visits, radiographs (X-rays) and treatments that are covered, and other services may be excluded. Some plans only reimburse patients when the least expensive treatment alternative is selected; other plans do not provide coverage for necessary treatments of pre-existing conditions.

Cosmetic dental procedures are not typically covered by dental insurance. However, if you have insurance and require veneers for restorative purposes, ask your dentist about the possibility of filing for reimbursement for a percentage of the costs.

Usual, Customary, and Reasonable (UCR) Fees

The most common term used by dental insurance companies on their Explanation of Benefits (EOB) statement to identify the fee for dental treatment is called Usual, Customary and Reasonable (UCR). UCR fees are determined by insurance providers based on the typical costs associated with various dental procedures.

For example, if your procedure costs $90, your dental insurance provider may have a UCR for the procedure of $60. You would therefore be responsible for paying the $30 difference as an out-of-pocket expense.

The following is a list of dental insurance companies we participate with.

32 BJ
ASO-SIDS
Aetna PPO/DMO/Vital Savings
Assurant
Ameriplan
Carrington International
Cigna DMO
Cigna PPO
Connection Dental
CSEA
DDS
DeCare
Delta Care HMO
Delta Dental
Dental Wellness
Dente Max
Dental Health Alliance
Eastern Benefit Systems
Empire BC/BS EPO
Empire Carpenters
First Ameritas
Fitzharris
GE Financial Assurance
GHI PPO
GHI Preferred
GHI Preferred Plus
Guardian Dental Preferred & PPO
Guardian Managed Dental Guard
Great West Insurance Co.
Healthplex
J.J. Stanis & Co.
Metlife
National Elevator
Northwest
Oxford Premium
Oxford Dental Freedom Plan
PBA
Pomco
Principal
Rayant
REMSCO
Uniformed Fire Fighters Associates
United Healthcare
Wellpoint
   
   



 
 
 
 


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