INSURANCE & PAYMENT OPTIONS

We accept most dental insurance plans and will file claims on your behalf, saving you the time and hassle. We will tell you upfront what your insurance plan will pay for and offer options for taking care of any remaining balance.

INSURANCE CARRIERS / PPO / HMO / MEDICAID / INSURANCE FAQ


INSURANCE CARRIERS

We accept and honor most dental insurance plans. The following are just a few of the dental insurance carriers we’re providers for:

Please call our office for more details at: (719) 301-5300


PPO

(Preferred Provider Organization) is the most common form of insurance. They provide members with a list of participating dentists to choose from. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000


HMO

Also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. Participating providers receive a monthly capitation check for patients assigned to the office. This amount is only a few dollars and is intended to offset the administrative costs. HMOs generally don’t pay for services rendered. Fees are usually greatly reduced, but the patient is solely responsible for paying the doctor.


MEDICAID

DENTAL CARE FOR MEDICAID & CHIP ENROLLEES

Dental health is an important part of people’s overall health. Medicaid is the government program providing dental assistance to those who qualify.  We believe everyone deserves to smile, so we’ve designed some opportunities in our practices to provide quality care to Medicaid patients.  These treatment plans include dentures and some family dental services (contact our office if you have questions).

DENTAL BENEFITS FOR CHILDREN IN MEDICAID

States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP).  Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.

Dental services for children must minimally include:

  • Relief of pain and infections
  • Restoration of teeth
  • Maintenance of dental health

The Early Periodic Screening, Diagnostic and Testing (EPSDT) benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.


INSURANCE FAQ

WHAT'S A COVERED BENEFIT?

Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group’s plan.

WHAT'S OPTIONAL TREATMENT?

Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.

WHAT'S THE DIFFERENCE BETWEEN INDEMNITY, PPO, HMO, & DISCOUNT INSURANCE PLANS?

Indemnity or Traditional Insurance reimburses members or dentists at the dentist’s UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without being limited to a panel.

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