Being out of network means that our office does not have a direct contract with your insurance provider. However, it does not mean that we do not accept your insurance. For those carriers with whom we have a direct contract, they offer in-network fees. When you visit us as an out-of-network provider, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to determine your financial responsibility.

We accept most major PPO insurances. Please note, we are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

Dental insurance operates on a similar premise to other employer-provided insurances like Medical and Vision. Typically provided through your employer, dental insurance involves monthly premiums and guidelines regarding provider networks and benefit variations.

However, a key distinction lies in the yearly maximum reimbursement limit imposed by dental insurance providers. In contrast, medical insurance continues to reimburse expenses after the individual meets their personal out-of-pocket maximum.

Dental insurance functions similarly to medical insurance, but with a distinct responsibility for "first money out." This means the insurance provider covers costs up to a specified "maximum allowable" amount within a benefit period (typically a year), while the patient is responsible for any expenses exceeding this limit. Understanding your plan's maximum allowable amount is crucial when considering more expensive treatments.

Additionally, like medical co-insurance, dental PPO plans categorize coverage into preventive, basic, and major services. For instance, many PPO plans offer 100% coverage for preventive services, 80% for basic services, and 50% for major services. It's essential to review your personal benefits to grasp the specifics of your coverage. Any services not covered by your insurance are the responsibility of the patient.

Dental insurance generally covers a broad spectrum of dental care, encompassing routine exams and cleanings (typically twice a year), basic procedures like fillings and crowns, as well as more complex treatments such as oral surgery and orthodontics.

These services are typically categorized into preventive, basic, and major categories, with each category covered at a predetermined percentage. For example, coverage percentages often break down as 100% for preventive care, 80% for basic procedures, and 50% for major treatments. The patient is responsible for paying any remaining balance after insurance coverage.

Orthodontic treatments have specific guidelines, including age restrictions, eligibility criteria within your plan, and often a lifetime maximum benefit instead of an annual limit. It's important to review your insurance plan details to understand these specifics regarding orthodontic coverage.

A PPO, or Preferred Provider Organization, allows you the flexibility to choose any dentist without needing a primary dentist designation. You also have the freedom to see a specialist without requiring a referral, although staying within your plan's network usually results in cost savings.

In contrast, HMO/DHMO insurance plans are structured to provide dental services at lower costs with minimal or no copayments. These plans require you to select a primary dentist or a dental facility with multiple dentists. You must stick with your chosen primary dentist unless referred to a specialist within the plan's network.