Dental Coverage (insurance plans)

 Dental (insurance) Plans

Please note that your health care and dental coverge are separate. Your dental coverage is usually administered by a different insurance carrier -- check your card.

 Your dental coverage is an agreement between you (or your employer) and your insurance carrier.  You are responsible for understanding your dental coverage, including its limitations, exclusions, and maximums.  We can verify that you have coverage, and estimate copays, but we do not have detailed information about your plan.  

We are happy to submit claims on your behalf to all traditional, employer funded and PPO style plans. We do not work with any dental HMOs

**You are responsible for payment of any services not covered by your dental plan**

2021 PPO Participation

During 2021 we are "in network" with the following PPOs:

  • Delta (Premier/PPO/Healthy Kids)
  • MetLife PDP/PDP Plus
  • Blue Dental PPO (currently includes DNOA - Dental Networks of America)
  • BCBS EPO
  • Guardian Dentalguard Preferred  (WE ARE NOT ACCEPTING NEW PATIENTS IN THIS NETWORK). Click here if you have dental coverage through Guardian

IIf you are in a PPO style plan not listed above, our practice is considered "out of network" with that plan.  We are happy to submit claims to all traditional, employer, and PPO plans. Please check with your plan administrator/insurance carrier for details on covered services and benefit payments.

A note to current patients: if you have a PPO not listed above and were told our practice is "in network" it is very likely a DenteMax plan.  Please click here for more information. Effective August 1, 2021 we are "out of network" with DenteMax plans.

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In April of 2020 we announced our intention to leave the DenteMax Provider Network. This process will be complete July 31, 2021.

DenteMax is a provider network which works with over 100 different insurance companies. Each of these insurers may use multiple networks. Check your insurance card for the DenteMax logo, or call your carrier to ask.

Please note that if you have a BCBS/DenteMax plan we are still in network with BLUE PPOs – call BCBS to verify how your benefits are paid.

How this will affect DenteMax plans used in our practice

We will continue to submit all claims for services in our office to your plan’s insurance carrier. If your dental coverage is through a DenteMax plan, you should expect that your benefits will be paid on your plan’s “out of network” payment schedule. Please review your plan’s covered services and the “out of network” payment schedule.

We are happy to submit a pre-determination request to your carrier in order to help you estimate your out of pocket costs.

We continue to welcome you to our practice but understand if you choose a participating provider.

We appreciate your patronage and apologize for any inconvenience caused.

Medicare and Medicare Advantage

Traditional Medicare plans do not include dental coverage. If you have purchased a supplement with dental coverage, please see the information above regarding plan participation.

MEDICARE ADVANTAGE: though these plans include dental, we do not participate with all plans!  Please carefully check your card for the name of your insurance carrier and plan.  WE PARTICIPATE ONLY WITH DELTA AND BLUE DENTAL PPO.  Many of the Advantage plans are HMO style plans (our office has never participated) -- PLEASE contact your carrier for information on claims payment.

 

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