Q. What insurance does your office take? 

A: We still accept most major dental insurance providers. However, are no longer in-network with any dental insurance. This just means that we are not contracted with any individual insurance provider and therefore we have no contracted procedure rates. Many dental plans, especially with Delta Dental, do include out-of-network coverage. Please check your insurance coverage as there may be full coverage for preventive care (ie: cleanings) and partial for other procedures. 

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Q: How do I find out how much my insurance will cover?

A: You can call your insurance or check your benefits online for most insurance plans and they can provide a more accurate estimate of your plan’s coverages. 

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Q: How does this change my co-pay?
A: We will collect up front for all patients and refund you once we are paid by your insurance. Any
amount you are not refunded is what your insurance does not cover. To get a comprehensive breakdown
of your plan’s benefits we encourage you to contact your insurance company via phone or check your
benefits online using your subscriber ID number associated with your dental insurance.

 

Q: If my insurance says it covers 100%, why do I still have a copay?
A: 100% refers to 100% reimbursement of the ‘allowed fee’ determined by your insurance provider. The
allowed fee is the cost your insurance deems to be an acceptable cost of service for a specific procedure.
However, this cost is not the actual cost of the procedure and is often much lower than the provider’s cost.

 

Example: Your insurance says they will pay 100% of the costs for preventive procedures, which includes
an exam. The cost of your doctor’s exam is $130, but your insurance only reimburses you $50 for the
exam. That is because the allowed fee for an exam under your insurance plan is $50. Your insurance paid
for 100% of that $50 portion.

 

Q: Why are you going out-of-network?
A: We have chosen to go out of network because insurance companies are decreasing both their coverage
for their patients as well as reimbursement for healthcare providers. This is a system that we do not
support because it doesn’t value adequate healthcare and doesn’t put patient needs first.
 

Q: Is there a discount for Delta Dental patients?

A: Yes. We reduced most of our fees for Delta Dental patients during this transition period. We want to alleviate some of the financial burden on our patients to show our appreciation. 

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Q: How much does my appointment cost?
A: We can tell you the amount we have to collect up-front. However, we won’t know what your insurance
will pay until after we submit the insurance claim following a completed appointment.

 

Q: Where will my reimbursement check be sent?
A: According to Delta Dental your reimbursement payment will be sent directly to you, the patient. Please
make sure you update your insurance of any changes to your address and contact information to ensure
you receive your payments.
 

Q: Will you collect up front for every single appointment?
A: We will collect up front for your first few appointments in order to gain an accurate estimate of your
coverage and an estimate of your future co-pays. We won’t be able to know how much an insurance plan
reimburses until we submit your claim following your completed appointment.

 

Q: How long will it take to get reimbursed by my insurance?
A: Delta Dental usually pays within two months, but if it’s been two months since your appointment we
recommend calling Delta Dental to check on your claim status. The only information you will need for

this is the subscriber ID and the date of birth for the family member whose appointment you’re calling
about.

 

Q: Can I use my HSA/FSA card for this?
A: Yes. However, please make sure you have your PIN handy, otherwise your payment may not go
through. Your PIN can be found or generated in your HSA/FSA online account in most cases.

 

Q: It’s been a few months. I haven’t received a reimbursement check from my insurance yet. What should I do?
A: Give us a call and we can contact Delta Dental to check on the status of your claim.

 

Q: What if I don’t have dental insurance?
A: For patients without dental insurance, we do have an in–office membership program that is approved
by the state of California. This membership includes 2 exams and 2 cleanings (including fluoride) every
calendar year as well as one emergency exam and all necessary x-rays. This membership operates on an
annual basis and costs $550, which is due at the time of membership contract signing. This is designed for
patients that want to maintain regular dental maintenance appointments. Members also receive a 20%
discount for most other dental services including crowns and fillings but excludes implants, dentures,
Invisalign, and veneers.

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Q: How can I submit claims to my secondary insurance?

A: There are two ways to submit claims to your secondary insurance.

The first way is to have our office do it. We would need the EOB, or explanation of benefits, from your

processed primary insurance claim. If you receive reimbursement payment directly, this

document would accompany that to explain the amounts your insurance is paying you. Email us

a PDF of that document and we can submit the claim for you to your secondary insurance.

 

The second way is to submit the secondary claim yourself. To do this, you will need the same

EOB mentioned above. You may be able to submit the claim via your online insurance portal.

You can reference the EOB from your primary insurance for any necessary procedure codes

and costs per procedure. If you prefer to mail in the claim, you can find the mailing address on

your insurance portal.

 

PLEASE NOTE: Since your secondary insurance claim has to wait for your primary insurance

claim to process in order to get the EOB, it takes an additional 3-6 weeks for processing in

addition to the original 3-6 week processing time for primary insurance. They cannot be

submitted simultaneously since the secondary insurance needs to know how much the primary

insurance paid.

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Q: Why does it take so long for my insurance to process claims?

A: We have to submit claims via mail which takes a few days. However, beyond that, any

delays would be the responsibility of your insurance provider. We encourage our patients to

advocate for themselves, and our front office staff are here to help in that process. We are

happy to contact your insurance to check on your claims status, pre-auth status, questions

about reimbursement, and benefits information. However, please note that as a provider, we

have limited access to information provided by your insurance and there are many topics you

will need to contact your insurance provider directly for due to privacy concerns.

 

Q: How do I know which plan is my primary insurance?

A: If you and your partner each have your own insurance and are also a subscriber as a

dependent on your partner’s plan, then the plan under your name is your primary insurance. If

you and your partner have children or additional dependents on each of your plans, most

insurance companies determine primary status based on which primary subscriber’s date of

birth comes first in a calendar year. It is not dependent on which plan is better/worse. If you are

subscribed to two plans under your name as the primary subscriber, the primary plan is usually

the plan you subscribed to first.

 

For more details on this membership or have any follow up questions or concerns to anything, please do not hesitate to email or call our office at (510) 523-5323 during our business hours.