Dental Insurance

Frequently Asked Questions

Do you accept my dental plan?

We accept a wide range of dental plans. Our featured providers are listed here.

The best way to check if we accept your dental plan is to contact one of our friendly and experienced reception team.

How much does my insurance cover?

Every insurance plan is different and is set up by your employer.  Typically your insurance will pay a percentage of the treatment required, and have a yearly maximum. The yearly maximum normally varies between $1,500 - $2,000.

Our team can help you identify what your specific coverage is, please call our office for assistance. Our friendly and informed staff will be happy to answer any questions you may have.

 
What does my insurance cover?

Every insurance plan has specific language that is designed between the insurance company and the employer.

We can help you navigate your insurance benefits. Call our office for assistance, our friendly and informed staff will be happy to answer any questions you may have.

 
How often does insurance cover crowns? and fillings?

Typically most insurance plans cover crowns to be replaced every 5 years, with some allowing replacement every 10 years.

With fillings, most insurance companies allow replacement every 1-2 years.

Every plan is different and our team can help get the specifics for your insurance.

How much insurance do I have per year?

Most insurance plans have a yearly maximum, between $1,500-2000. The maximum is for all dental treatment (including cleanings, exams and x-rays).

Does my insurance have a deductible?

Most insurance companies have a deductible that is between $50-100 per year. This deductible is normally waived for preventative procedures (cleanings, exams and x-rays).

Why didn't my insurance cover the procedure?

Although we try our best to estimate our patient's out of pocket expense, there are many subtleties, or fine print, in the contract between the patient's insurance and employer.

Some of the things that we do not always know about are frequencies, limitations, down grading of procedures, missing tooth clauses, and many more.

If patients have a booklet from their employer or insurance, it is helpful in determining a better estimate.

Why do I have a deductible?

Unfortunately, we have no control over what the insurance company and employer have negotiated in the insurance plan. So usually the deductible is a way to help offset some of the insurance cost.

Fortunately, in dentistry, the deductibles are much lower than with medical insurance.

How often can I have cleanings?

Most insurance plans cover 2 cleanings per year, with exceptions of up to 4 cleanings a year.

Why do I have a balance?

Although we try our best to estimate our patient's out of pocket expense, there are many subtleties, or fine print, in the contract between the patient's insurance and employer.

These intricacies can cause the insurance to pay a different amount than anticipated.

Another reason for a balance is if the insurance company argues the necessity of a procedure.

Is there any orthodontic coverage?

Many insurances cover orthodontics (braces, Invisalign or clear aligners). However, the coverage depends on the contract between the employer and the insurance company. There is usually a separate insurance allowance for orthodontics and many times there is an age limit.

Are you preferred with my insurance plan?

We are preferred with most insurance companies, and likely are in network with your insurance plan. We are in network with these major insurance companies such as Delta Dental, Aetna, Cigna, Metlife, Regence, Premera, Blue Cross, United Concordia, and many more. If you have a specific question on your insurance plan it would be best to contact our office. Our friendly and informed staff will be happy to answer any questions you may have.

 
Are there limits to what insurance will pay?

Yes. Insurance companies are a business and they will have limits on what they will pay. These limits can be things like a yearly maximum, subtle clauses to downgrade treatment or allow cheaper treatment.

Can I buy an individual dental plan?

Yes. Many insurance companies offer individual dental plans. If you are looking at them, please contact our office and speak to us directly, as sometimes the cost of these plans may be higher than not having any insurance.

How does my dental plan work?

Every insurance dental plan is different. We start with getting verification that our patient has insurance coverage and we get a general break down of benefits. Then when treatment is needed we use these benefits to estimate what the patient's out of pocket would be. As a courtesy to our patients, we then bill the insurance company for the treatment rendered. The insurance company usually takes 4-6 weeks to reimburse our office for the cost of treatment.

Do I have orthodontic or implant coverage under my insurance plan?

Many insurances cover orthodontics (braces, Invisalign or clear aligners). However, the coverage depends on the contract between the employer and insurance company. There is usually a separate insurance allowance for orthodontics and many times there is an age limit.
Implant coverage usually falls under the general dental insurance category. However, this coverage is dependent on whether your employer has selected to have implant coverage. We can help try to find out if implants are covered.

Get in touch and we will get back to you

Contact South Hill Dental to schedule an appointment or to request additional information about our services. We look forward to hearing from you.