Insurance Options

We're in network with MetLife, Ameritas, Mutual of Omaha, Guardian, Aetna, Principal, Humana, Sun Life, Lincoln Financial, and Assurant, and we accept most other insurances. Call 941-423-4334 and we'll check your plan.

An in-network dentist has a contractual agreement with your insurance company or network and has agreed to certain contracted fees. An out-of-network dentist doesn't have that same agreement. Depending on your plan, you may have different benefits or a higher out-of-pocket responsibility when you see an out-of-network provider. Your insurance plan determines whether you have in-network or out-of-network benefits and how those benefits are applied.

Not necessarily. Dental insurance is designed to help with the cost of dental care, but every plan has its own rules, limitations, exclusions, and restrictions. Your insurance benefits don't determine what treatment you need. Your dentist recommends treatment based on your oral health.

No. Your dentist's treatment recommendations are based on your dental health and clinical needs, not on your insurance benefits. You always have the right to discuss treatment options and costs with our team before going ahead.

Insurance companies offer many different plans, and benefits can vary a lot between employers and individual policies. Two patients may have the same insurance company but completely different deductibles, annual maximums, frequency limitations, coverage percentages, and exclusions. That's why we verify benefits based on your individual policy whenever possible.

A deductible is the amount you pay toward eligible dental services before your insurance starts paying according to your plan's benefits. For example, if your plan has a $50 deductible, you may be responsible for the first $50 of eligible services before your insurance begins contributing. Deductibles vary by plan and may apply differently to preventive, basic, or major services.

Your annual maximum is the most your dental insurance plan will pay toward covered dental services during a benefit period, usually a calendar year. Once you reach it, you're responsible for the remaining cost of covered and non-covered services until your benefits renew. Your annual maximum isn't the same as a deductible or an amount you owe the dental office.

Yes. Many dental plans limit how often certain procedures are covered, such as cleanings, X-rays, fluoride treatments, and periodontal maintenance. Even if your dentist recommends treatment sooner because it's clinically necessary, your insurance may not pay if you've gone past your plan's frequency limitation.

A waiting period is a length of time you may need to be enrolled in a dental insurance plan before it will pay for certain services. Waiting periods can apply to basic or major procedures, depending on your plan. Your insurance may be active even if a waiting period applies to certain treatments, so we recommend checking with your insurance company to see whether one applies to yours.

A missing tooth clause is a limitation in some dental insurance plans that may keep the insurance company from paying to replace a tooth that was missing before your coverage began. This can affect treatment such as bridges, dentures, or implants.

Some plans provide an "alternate benefit," also called a downgrade. This means your plan may pay based on a less expensive treatment option, even when your dentist recommends a different treatment. For example, your dentist may recommend a crown, but your plan may calculate its payment based on a filling or another covered procedure. You're still responsible for the difference between the insurance allowance and the cost of the treatment you choose.

Some dental plans use alternate benefits or downgrades. Your insurance company may base its payment on another, less expensive procedure that the plan considers an allowable alternative. Your dentist's recommended treatment is based on your individual dental needs, while the insurance company's payment is based on the terms of your insurance contract.

Coordination of benefits (COB) determines how dental benefits are paid when you have more than one dental insurance plan. If you're covered by two plans, one is generally your primary insurance and the other is secondary. Having two plans doesn't necessarily mean 100% of your treatment will be covered, because each plan has its own rules for coordination and payment.

A pre-treatment estimate is a request sent to your insurance company before treatment. The insurance company reviews the proposed treatment and estimates how it may be covered under your plan. It can help you understand your potential benefit and estimated cost, but it isn't a guarantee of payment, and your actual benefits may change before the claim is processed.

We can help get and explain information from your insurance company, and we may submit a pre-treatment estimate when appropriate. However, only your insurance company can determine how your benefits will be applied to a specific claim. Because policies can change and benefit information from an insurance company isn't a guarantee of payment, we recommend contacting your insurance company with any questions about your specific benefits.

A pre-treatment estimate is based on the benefit information available to the insurance company when it's processed. The final payment may differ because of changes in your benefits, deductible, annual maximum, frequency limitations, alternate benefits, claim processing rules, or other plan limitations. The insurance company makes the final decision when the claim is processed.

Insurance payments are based on the specific terms of your plan. Your claim may be affected by your deductible, annual maximum, frequency limitations, missing tooth clauses, alternate benefits, waiting periods, exclusions, or whether your dentist is in or out of network. An insurance estimate isn't a guarantee of payment, and the insurance company makes the final decision when the claim is processed.

A plan that says it pays, for example, 80% of a service doesn't necessarily pay 80% of the dentist's actual fee. The percentage is generally applied to the insurance company's allowed or contracted amount, after deductibles, limitations, exclusions, and other plan provisions are considered.

Dental insurance isn't meant to cover 100% of all dental treatment. Your balance may come from deductibles, co-insurance, annual maximums, frequency limitations, alternate benefits, exclusions, or services your plan doesn't cover. Your treatment is based on your oral health needs, while your insurance company decides how much it will contribute.

An EOB, or Explanation of Benefits, is a statement from your insurance company explaining how a claim was processed. It generally shows the amount billed, the amount the insurance company allowed, what insurance paid, and what you may owe. An EOB isn't a bill from our office.

Your insurance company may have applied a deductible, co-insurance, annual maximum, frequency limitation, alternate benefit, or other plan restriction to your claim. The amount estimated before treatment and the amount paid after the claim is processed can be different, and your EOB reflects the insurance company's final decision.

A denial doesn't necessarily mean the treatment was unnecessary. Insurance companies may deny claims because of plan limitations, exclusions, frequency restrictions, alternate benefits, missing tooth clauses, documentation requirements, or other contract terms. When appropriate, our office may review the denial and help with an appeal or send additional documentation supporting the treatment.

If you believe your claim was processed incorrectly, you can contact your insurance company using the customer service number on your insurance card. Our office can also review the EOB and, when appropriate, help submit additional information or an appeal. Remember that your insurance company, not the dental office, makes the final decision about your benefits.

Yes. Benefits can change because of plan changes, ended coverage, changes to your annual maximum, deductible, or frequency limitations, or other circumstances. That's why information provided before treatment is an estimate and can't guarantee what your insurance will pay.

Your insurance card, a photo ID, and [other items, such as new patient forms].

We offer discounts for patients without coverage. Call us at 941-423-4334 to learn more.