Dental Insurance
At Bliss Pediatric Dentistry, we prioritize your dental health. We’d love to help you maximize your insurance benefits. If you have any questions about your insurance coverage or need to schedule an appointment, contact our team today.
We’re here to help whenever you need us.
PPO insurances we accept:
Metlife
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CIGNA
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Aetna
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Humana
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GEHA
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Sun Life Financial
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Blue Cross Blue Shield
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Metlife • CIGNA • Aetna • Humana • GEHA • Sun Life Financial • Blue Cross Blue Shield •
As part of our commitment to providing excellent service, we offer to check your dental insurance coverage details before your appointment. To facilitate this process, please have your dental insurance information ready when you schedule your appointment. If needed, we can also submit a pre-treatment estimate to your insurance provider on your behalf.
It's important to note that filing insurance claims is done as a courtesy for our patients, as we do not have a direct contract with your insurance company – you do. Insurance policies can vary significantly, and while we make every effort to provide an estimate of your coverage in good faith, we cannot guarantee it due to the complexities of insurance contracts. For specific questions about your coverage and benefit information, we recommend reaching out directly to your insurance provider.
Dental Insurance Fact 1 - NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is intended to assist with the cost of dental care, but it's important to understand that no insurance plan covers 100% of all dental fees. Some patients mistakenly believe that their insurance will pay 90% to 100% of the total dental expenses, which is not accurate. Typically, dental insurance plans provide full coverage for preventive and diagnostic care, while offering partial benefits for other services, typically ranging from 50% to 80%. The specific percentage covered is usually determined by factors such as the amount paid for coverage by you or your employer, or the type of contract established between your employer and the insurance company.
Dental Insurance Fact 2 - BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that your dental insurance company reimburses you or the dentist at a lower rate than the dentist's actual fee. Often, insurance companies explain this by stating that the reimbursement was reduced because the dentist's fee exceeded the usual, customary, or reasonable fee ("UCR") set by the company.
This explanation may lead to the misconception that any fee higher than the amount paid by the insurance company is unreasonable or significantly above what most dentists in the area charge for the same service. However, this is misleading and inaccurate.
Insurance companies establish their own fee schedules, and each company uses a different set of fees that they consider allowable. These allowable fees can vary widely because each company collects fee information from the claims they process. The insurance company then selects a level they label as the "allowable" UCR fee. It's important to note that this fee data can be several years old, and the insurance company sets the "allowable" fees to ensure a net profit of 20% to 30%.
Unfortunately, insurance companies may imply that your dentist is charging too much rather than acknowledging that they are underpaying or that their benefits are limited. Typically, less expensive insurance policies use a lower usual, customary, or reasonable (UCR) figure.
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Dental Insurance Fact 3 - DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED
When estimating dental benefits, it is essential to take deductibles and coverage percentages into account. Let's consider an example: Suppose the fee for a particular service is $100. If your insurance company recognizes $100 as its usual and customary (UCR) fee and covers 80% of this procedure, the breakdown would be as follows:
$50 Deductible (this is an average value)
80% coverage of $100 = $80 from insurance; the patient's responsibility would be $20.
The total amount due from the patient would be $70 ($50 deductible + $20 co-payment).
Of course, if the UCR fee is less than $100 or your plan only pays at 50%, the insurance benefits will be significantly lower as well.
Out of Network
We welcome families with various insurance plans as a non-participating/out-of-network provider. This implies that, depending on your specific insurance plan, there may be an additional fee or co-pay involved, although it's also possible that no additional charges apply. It's worth noting that numerous insurance plans offer out-of-network benefits that are comparable to or on par with in-network coverage. If you are considering becoming our patient, we are pleased to verify your out-of-network coverage details. Please don't hesitate to get in touch with our office and provide your dental insurance information.
Secondary Insurance
If you have secondary insurance coverage, it is important that both insurance plans are aware of each other. When scheduling your appointment, kindly provide the information for both insurance plans. It may be necessary to complete additional forms during the check-in process. Please be aware that we do not coordinate benefits with any Medicaid plans. Please be aware that although you may have secondary insurance, the secondary insurance may not pick up 100% of the remainder of the patient responsibility (each insurance plan varies). Thank you for your understanding.