We’ve put together some of our frequently asked insurance questions. We hope that these will answer some of the questions that you may have regarding your insurance policy. As always, we are here to help, so please call if you still have questions for us. The answers to some questions may best be answered by your insurance company.
Do you accept my insurance?
We do accept most insurance plans; however, we are not a “preferred” provider with any insurance company. As a courtesy to our patients, we do file all dental claims on your behalf. Keep in mind dental insurance is different from medical, it is meant to be an aid in receiving dental care. Depending on your contracted dental coverage, it is likely there will be some out-of-pocket expense for your child’s treatment.
What is the difference between in-network and out-of-network?
In-network providers enter into a contractual agreement for fees charged to the patients of that insurance carrier. The dentist has agreed to that amount of reimbursement from the insurance and is not able to balance bill the patient (we write off a portion of the office fee). Out-of-network providers submit the office fee and balance bill the remaining uninsured portion. Even though we are out-of-network, our fees are kept low (according to network surveys for our area), often, there is little to no out of pocket expense.
What is the difference between PPO and Premier?
Delta Dental has two tier levels for a dental provider to enter. We have chosen to be in the premier network only. There are a large percentage of Washington dentists in the Premier and/or the PPO network. Depending on the policy you have this could mean a number of things: your deductible could apply for routine care (where it would not at a PPO office), a slightly higher out of pocket portion, no coverage for non-PPO provided services or nothing at all – many plans have no difference in percentage covered for a Premier vs. PPO dentist.
What will my out of pocket expense be?
This varies with each individual plan. There are many factors to consider: deductibles, frequency limitations, coverage percentages, and your insurances “UCR” (Usual, Customary and Reasonable – the fee deemed allowable by your insurer). Many patients think that their insurance pays 90%-100% of all dental fees. This is untrue: most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. Many times, we are able to look up an employer’s plan and give you a good estimate.
Do you offer cash discounts?
We are committed to keeping our fees fair and providing quality dental care. Payment options are always available; please contact our financial coordinator for more information.
Can I pay out of pocket if I have DSHS/HCA/Provider One/Molina (state covered) insurance?
No. As a contracted provider with the state of Washington, we could lose our ability to accept and care for patients if we allow for additional payments from our DSHS patients.