Insurance & Financing

How Does Dental Insurance Work?

Dental insurance isn't truly insurance and should be understood as more of a benefits plan or gift card. Most dental plans have a maximum benefit of $1500 per year and will not pay anything beyond that, whether the care is necessary or not. (Can you imagine a home or auto insurance policy that maxes out at a few thousand dollars?) Unfortunately, dental insurance has not changed much in the last 4 decades. Technologies have improved and procedures have become more advanced, but while premiums have steadily increased, benefits have actually become more restrictive and complex. Both patients and providers are obscured from these often deceptive practices and the patient-provider relationship has been increasingly strained over these nuances. 

If you've received dental coverage through an employer or purchased your plan on an insurance exchange, you will likely have an HMO or a PPO plan. With an HMO plan, you will be assigned a dentist that your coverage is eligible for. With a PPO plan, you are free to choose any dental provider and still receive benefits from your plan.

How Much Does Insurance Cover if I Receive Care at Lake Merritt Dental?

As a courtesy to our patients, we offer complimentary insurance benefits analyses by contacting your insurance plan for an estimate for how much they will pay for your care. At your appointment, we will request payment for the insurance company's estimation of your responsible portion. For example, if our fee is $100, and your insurance company claims to cover 80% of that procedure, you will be responsible for $20 of that visit upfront. Upon completion of your treatment, we will submit an insurance claim on your behalf. Often times, insurance companies pay less than what they estimate, in which case, we will send you a statement for the remaining balance of your bill. In this example, if the insurance company actually only pays $74 instead of $80, you will receive a bill for $6.

How Do I Decide Which Insurance Plan to Choose?

Good dental plans pay for dental treatment based on average area fees for dental care. Some plans may claim to cover 100% of your routine hygiene visit, but what they won't tell you is that they may only cover 100% up to $60 for a preventative visit. A better plan will cover 100% of the average area fee of around $125 for a preventative visit. Always ask to compare maximum contract allowances for certain common procedures like cleanings, exams, fillings, and crowns instead of just choosing based on the percentages described by the plan.

If you are shopping for a plan, or trying to choose one that your employer has offered, give us a call and we may be able to help you in selecting the one that best fits your needs.

What if I Don't Have Insurance?

Not having dental insurance does not mean you do not have access to affordable quality care. In order to address the problems associated with dental insurances, we have begun to offer our own in house membership plan, so that we may cut out the middle man and pass on the savings directly to our community members. Please head over to our MEMBERSHIPS section to learn more and sign up.

We accept all PPO plans including but not limited to the following:
  • Aetna PPO

  • Anthem PPO

  • Assurant PPO

  • Blue Cross of any state, PPO

  • Blue Shield of any state, PPO

  • Cigna PPO

  • Coresourse PPO

  • Cisco PPO

  • Delta Dental of any state, PPO or Premier

  • Empire PPO

  • First Dental Health PPO

  • Guardian PPO

  • Horizon PPO

  • Humana PPO

  • Kaiser Dental Plans KPIC

  • Lincoln Financial PPO

  • Local (in CA) Unions, PPO

  • Local (in CA) Insurance Companies PPO

  • Metlife PPO

  • Mutual Of Omaha

  • Premier Access PPO

  • Principal PPO

  • Reliance Standard PPO

  • Sunlife PPO

  • Standard PPO

  • United Concordia PPO

  • United Health Care PPO
     

We do not accept Denti-Cal or HMO plans at this time.
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