Many patients have questions concerning their insurance coverage. Because we believe patients deserve the best service possible, we at Kids Only Dental strive to help in educating our patients with their individual insurance coverage.
Please be aware that your insurance is between you and your employer. If there is ever any changes to your policy, you are notified, not us. What we expect from your insurance is an estimate, and you are financially responsible for payment. Our intention is to help maximize legitimate reimbursement. Feel free to contact us anytime with insurance questions; we are here to help assist you.
Plan Basics: Dental PPOs generally offer lists of participating doctors. This does not always mean that it is a requirement for the patients to choose. You have the freedom to choose any office, however keep in mind, benefits may differ.
HMO or DMO: You choose a primary care dentist. If you need to see a specialist (ex: pediatric, orthodontist, endodontist, etc.), your primary care dentist gives you a referral to another participating dental office.
Annual Maximums: This is the maximum dollar amount your dental plan will pay during your contract, calendar, or fiscal year.
Benefit Categories: Preventive and Diagnostic (exams, cleanings) (sealants, X-rays, etc. may also be subject to deductible and considered a basic service) Restorative or Basic (fillings, simple extractions, root canals, etc.)
Deductibles: A deductible is the amount of money that you must pay before your benefit plan will pay for services. It is determined by your employer if deductibles are stipulated for all benefit categories, or if waved on Preventive and subject to Basic Restorative. The dollar amount is usually per enrollee, with a family maximum.
Coinsurance / Contract Benefit Levels: The member’s share, as a fixed percentage, of the allowable amount to be charged. For example, a benefit paid at 80% results in a 20% coinsurance (or copayment) responsibility of the member. Coinsurance applies after the required deductible has been met.
Limitations and Frequencies: Your dental plan may not cover every dental procedure. Each plan lists specific procedures that may not be a covered service under your policy. Limitations may be associated with frequency (the number of a specific procedure ·permitted during a stated period of time. (ex: exams covered two times in a calendar year/one time every six months/one time in 12 months). Additionally, there are usually age limitations to certain procedures along with frequencies (ex: tooth sealants covered one time in 36 months up to but not including age 14).
We are in network with:
- Cigna PPO
- Delta Dental PPO
- Aetna PPO II
- Guardian Preferred
We also work with other PPO plans (Metlife PPO, Aetna PPO, etc.) and/or submit for payment on your behalf. For any other insurance carriers, or if you have any questions regarding your specific policy, please inquire at our office for full coverage details.