Receptionist

DENTAL INSURANCE

ATTENTION HMO PLAN MEMBERS: YOU MUST CONTACT YOUR DENTAL PLAN & ASSIGN DR. KEE AS YOUR PRIMARY CARE PROVIDER PRIOR TO SCHEDULING.

We are participating providers with most major dental insurances. Popular plans we participate with include Aetna, Carefirst BCBS, Cigna, Delta Dental, GEHA/Connection Dental, MetLife, United Concordia, and United Healthcare. We also are providers for Maryland Physicians Care and Maryland Healthy Smiles for Children/


Please note: that even with preauthorization, insurance will never guarantee payment. We verify eligibility for every patient, and we truly make every possible effort to ensure accuracy because we want you to have a great experience. However, every insurance company is different, they will not guarantee coverage or eligibility, and can even refuse to provide specific dollar figures. If specifics are not provided by your insurance company, we will estimate based on what is standard for an average plan. Ultimately, your actual coverage may be different than the estimate.

 

DENTAL INSURANCE FAQS

WHAT PLAN IS THE BEST? HMO OR PPO?

Generally, a PPO plan will provide the best dental coverage because you will have more dentists and dental specialists to choose from. HMO plans are fine for patients who only need check-ups and fillings. However, HMO plans provide limited access and longer wait for dental specialists that patients may need for root canal and surgical services.



WHY DID MY INSURANCE DENY?

Insurance companies make their profits off of premiums and denying pay-outs. They do not guarantee benefits but only estimate what they will cover. The final decision is made once the work is already completed and the claim is billed. Limitations such as for frequencies allow adjusters to deny. For instance, a plan may cover a PAN x-ray every 5 years, but you may have a problem year 4 requiring a new x-ray before they will cover it again.

IS THERE A LONG WAIT FOR HMO MEMBERS?

No, patients that are currently on our patient list do not have a wait and can book our next availability. Transferring patients must wait until they are on our patient list.

WILL MY INSURANCE COVER MY VISIT?

Most dental insurance will cover the majority of your exam, x-rays, and preventive care. Deductibles commonly apply to other services like gum treatment, fillings, crowns, and dentures. After the deductible is paid, insurance usually pays between 50-80% of the total cost of treatment.

IT'S OPEN-ENROLLMENT SEASON, WHAT PLAN SHOULD I BUY?

When plan shopping, you should consider your current dental health. If your teeth and gums are healthy and just need cleanings for maintenance an HMO plan may suffice. However, most people benefit best from a comprehensive PPO plan. PPOs offers a wider range of covered services and are widely accepted by general dentists and specialists.

WHAT IS A DEDUCTIBLE?

A deductible usually applies to non-routine services like fillings, crowns, dentures, ect. The deductible is only charged once per year or contract period for applicable services. This means the patient will pay slightly more for their first applicable services because they wil pay their deductible plus the copay.

I DIDN'T USE MY BENEFITS, DO THEY ROLLOVER?

Benefit plans do not typically rollover. Calendar year plans expire December 31st and the patient loses any leftover benefits. Contract plans expire per the expiration date of the contract (usually July).

DO YOU OFFER FINANCING OPTIONS?

Treatment plans over $500 can be financed for up to 24 months. The first visit cannot be financed.