Dental insurance helps with costs, but it doesn’t decide your care—we do, based on your health. We’ll work with your plan to maximize benefits, but all balances are ultimately the patient’s responsibility.
Networks: We are in-network with many PPO plans [list plans here]. We’ll submit claims for both in-network and out-of-network benefits as a courtesy.
Estimates, not guarantees: Any copay/coinsurance we quote is based on information from your insurer and may change once the claim is processed. You’re responsible for any difference after the Explanation of Benefits (EOB).
What can change your benefit: Deductibles, annual maximums, waiting periods, frequency limits (e.g., cleanings, x-rays), non-covered or cosmetic services, and “alternate benefit/downgrade” rules (e.g., composite vs. amalgam, implant vs. bridge).
Pre-treatment estimates: Available on request. Insurers call these “predeterminations.” They help, but they are not a payment guarantee.
Payment timing: Your estimated portion is due at the time of service. We accept cash, major cards, HSA/FSA, and [financing option, e.g., CareCredit].
Dual coverage: If you have more than one plan, the primary plan pays first. Bring both insurance cards so we can coordinate benefits.
Claim follow-up: We track claims; if an insurer has not paid within 45–60 days, the remaining balance may be transferred to you while we continue to assist with documentation/appeals.
Referrals/DMO/HMO plans: Some plans require you to see an assigned provider or have a referral. We [are/are not] contracted with DMO/HMO plans; without the required referral/assignment, benefits may be denied.
Medicaid/CHIP: We [do/do not] accept Pennsylvania Medicaid/CHIP dental plans. If not, we can provide estimates and receipts for self-pay.
Orthodontic benefits: Often separate from general dental benefits and paid monthly/quarterly by insurers. We’ll outline your specific schedule.
Records & x-rays: We’ll supply necessary records to your insurer upon request.
Missed appointments: Appointment reservation fees and late-cancellation fees are not covered by insurance.
Questions about your coverage? Call the number on your insurance card for plan-specific details, then share any updates with our team. This policy is general information, not legal or insurance advice.