INSURANCE

In our office, we offer high quality care and payment options that work for all of our patients. We accept any PPO plans with out-of-network benefits. For most plans, the percentage of coverage for in vs. out of network is usually the same. Once you scheduled, we will be happy to complete a complimentary/courtesy benefits check for you. We are not a Medicaid or HMO insurance plan provider. Other discount plans purchased elsewhere are not accepted in our office.

In Network Vs. Out of Network Coverage:

If you come to see us and you are “out-of-network,” it simply means that if there is a difference between our fee and the allowable fee set by your insurance, you are responsible for the difference. Our fees are based on “Usual and Customary Rates” or UCR for our area (based on zip code) and are usually still within or very close to the allowable fees set by a lot of insurance companies who base benefits on the UCR. You can find UCR fees based on our zip code (98370) on https://www.fairhealthconsumer.org/ For most patients using their out-of-network benefits, for preventive and diagnostic services, there will often be either a $0 or very minimal out-of-pocket cost. A lot of our patients have out-of-pocket costs between $20 and $40, but still prefer to come to us due our great customer service.

If your insurance bases coverage off of a set fee schedule, this means that they will pay the designated percentage of coverage for any given service up to the fee that they allow. The fees “allowed” by plans using a fee schedule are usually much lower than the actual fees at our office or many other offices in the area. You should expect to have an out-of-pocket cost (sometimes a sizable one) if you have an insurance plan that pays off of a fee schedule. This is something we can find out for you or you could always make a phone call to your insurance company and ask.

Also, keep in mind that when you are using your out-of-network benefits, it also means that you are not usually subject to as much downgrading for services. Some insurance companies stipulate downgrades for certain procedures for patients using in-network providers. For example, your insurance may estimate to pay a higher percentage if you are going to an in-network provider, but, say, you need a filling on a back tooth. If you are going in-network, some insurance companies will say they will only pay amalgam (silver colored filling), not the composite (tooth-colored filling) that our office does and which almost all patients want. For going to an in-network provider, you are subject to that downgraded benefit and responsible for the difference. If you go to an out-of-network provider, insurance sometimes doesn’t have those same stipulations.

There are thousands of different insurance plans with all different stipulations for services. Not all plans are the same within the same insurance company. We check on your insurance coverage and submit your benefits on your behalf as a courtesy. You are still responsible for understanding and knowing your benefits.

Payment Options:

  • Flexible Payment Plan: Pay a portion up front, and the rest over an agreed upon time period for multi-step procedures such as crown, dentures, implants, etc.

  • Check or Credit Card: Always accepted.

Other Options:

 

PLEASE NOTE: PAYMENT IS DUE AT THE TIME OF SERVICE.

As a courtesy to you, we will bill your insurance company and track your dental claims. Please keep us informed of any changes to your insurance plan. You are responsible for the fees charged by our office, no matter what your insurance coverage may be. Most insurance companies should respond to the claim within four to six weeks. Any remaining cost is your responsibility.