Financial/Insurance Information

Financial Information:

• Elite Dental accepts all PPO insurance, but it is important to understand that dental insurance is diverse. Whether in-network or out-of-network, some policies cover a small percentage of fees, while others cover 50 percent or greater. 
• We will be happy to check the details of your specific plan to see what your expected coverage is and how your insurance reimburses for procedures. Most patients are surprised their insurance will cover the same or a similar percent of coverage whether in-network or out-of-network. Patients may pay an additional small copay for out-of-network providers, but many find it worthwhile in exchange for the increase in time and quality provided. 
• Payment for services in-full and upfront or partial payment will be determined by your benefits. We will submit claims and supporting documentation to your insurance carrier when using in-network or out-of-network PPO benefits.
• Preventative procedures such as X-rays, routine cleanings, exams and fluoride treatments are likely to have a higher percentage of coverage if you have an in-network or out-of-network PPO plan. Restorative treatment such as fillings, partial crowns, crowns, replacing missing teeth or orthodontics may be covered at a certain percentage, however it is largely dependent on the specific guideline of your plan and your insurance company’s policies on whether services will have benefits.
• Cosmetic treatment is not a covered insurance benefit. We offer third party financing options to make the dentistry you desire affordable. 
• Our team and dentists invest time with each of our patients. We offer a number of technologies, high quality material, and comfort services to improve your dental care and the overall experience. Our dentists invest in more continuing education than is required to provide the best dental care possible. Fees set by an insurance provider likely do not reflect the type of care and service we consider standard.
• Your annual maximum is the amount your insurance company will pay in a calendar year/rolling 12 months. Usually, that amount is around $1000. If the maximum is not used before the year ends, you lose it, and the maximum amount restarts. This amount typically covers your routine cleanings, exams and X-rays throughout the year, as well as 1-2 fillings or part of a crown.
• If your insurance provider does not pay their estimated portion or deems a service non-covered, you are responsible and will be billed for the balance. Our team uses all paperwork, charts, X-rays and photos necessary to optimize your benefits while we file your claim.

Why should I consider an out-of-network provider or not using insurance at all? 

While insurance premiums increase annually, often a patient's benefits and amount of coverage stay the same. Similarly, the allocated amount an insurance company will pay a dentist for their services may stay the same, rise minimally each year (not in keeping with inflation/staffing costs), or even decrease. This means dentists who are in-network with many insurances may have to schedule “efficiently” with shorter appointments for procedures, choose less desirable materials/labs, work with more inexperienced team members and are unable to keep up with available technology.

Would you prefer to decide what treatment is right for you, or do you trust an insurance company to choose? Despite availability of insurance benefits to a patient, insurance companies often try to dictate treatment decisions by either denying benefits because treatment does not fall under extremely specific parameters, or downgrading a proposed treatment like paying for a silver filling instead of a white filling. Many insurance-driven parameters favor reactive treatment, such as paying for a porcelain crown only when a tooth is grossly decayed or part of the tooth has completely fractured. In contrast, dentists often prefer recommending particular restorations before a tooth is extensively damaged with the intent of requiring less treatment overall. Our patients at Elite Dental Center often make informed decisions and choose to pursue recommended procedures, regardless of whether insurance will participate in paying their portion of benefits. However we have heard it time and time again from patients, “why am I paying for this insurance “coverage” in the first place?”.

We encourage you to call your insurance company and learn more about your benefits, however keep in mind that insurance companies use scare tactics to train consumers that out-of-network providers are “bad”, more expensive and should be avoided at all cost. Their websites use language like, “beware of out-of-network providers,” and “avoid paying high out-of-pocket costs.”  They don’t explain that even with in-network insurance benefits, there will still be out-of-pocket costs, or that recommended treatment with an in-network provider could be downgraded or even denied by your insurance company, again leaving you with the cost. Most patients are surprised that their insurance will cover the same or a similar percent of coverage whether in-network or out-of-network. Patients may be responsible for only a small additional copay for out-of-network providers, but many find it worthwhile in exchange for the increase in time and quality provided.

What are the benefits of paying cash (not using insurance) for dental treatment?

As mentioned above, insurance companies introduce a lot of hassle in trying to get procedures covered and confusion as to what a patients out of pocket costs will actually be. When paying in cash, you will have a clear understanding of your costs up front and can plan and save accordingly for the procedures you need.

Not only that, but if you are a patient paying in cash, we are happy to offer a discount! Most dentists will offer a discount for patients paying cash since they don’t have the added overhead expense of filing insurance claims, dealing with denials or collecting for non-covered services.

Elite Dental has always been committed to delivering quality dental work and spending the necessary time with our patients to achieve the best results possible. We refuse to compromise how we deliver dental care, and so have chosen to change how we partner with insurance companies so our patients can receive the care they have come to expect.