Insurance/
Financials

We accept most major PPO plans!

• Aetna
• Altus
• Ameritas
• Dental Network of America (DNOA)
• MetLife
• Principal
• Careington Platinum
• Cigna
• Guardian
• United Health Care
• Blue Cross Blue Shield
• Delta Dental
• SunLife

...and more!

We also accept “CareCredit” and can help you apply for a “CareCredit” Payment plan.

**click below to learn more and apply

Insurance and Financial Information

Here at Restoration Smiles, it is our main priority to provide you with the highest quality of care and we do not allow insurance companies or finances to compromise our treatment recommendations. We will always make recommendations on what is considered the highest standard of care and what will provide you with the best possible outcome, not by what insurance covers. However, we understand that dental care can be costly and we are happy to help mitigate the financial burden by accepting most insurance plans, offering financing options, and also an in-office membership savings plan. If your insurance changes or updates, please contact us as soon as possible to provide your new insurance information.

Although we accept most major insurance plans, we recommend you call your insurance to verify your network status with our office and ask any questions about costs prior to your visit. Your coverage is a contract between you and your insurance company. If you choose to use your insurance plan you are responsible for knowing the benefits and limitations of your insurance plan/coverage.

Insurance plans can be  very complicated and every employer plan has different coverage limitations. For instance there are 100’s of different “Delta Dental plans” and no two are alike. As your provider, we do not know how much of your coverage you have already used at other offices. Your insurance does not report this information to us in real-time.  Therefore, we recommend all new patients call their insurance company to ask some questions to be best prepared for any unexpected out-of-pocket costs. For questions, see Insurance Worksheet below.

Unexpected Costs for Exams/Cleaning

At your initial new patient appointment,  a comprehensive exam (D0150) and a full set of intra-oral xrays (D0210) will be performed for adults. For children, a comprehensive exam  (D0150), bite-wing xrays (D0274) and select PA x-rays (D0220) will be completed. We typically do not ask for payment for these initial new patient visits, or any periodic exam/cleaning visits, unless we know that you have met your frequency limits. We send these directly to your insurance for payment first, because most of the time, they are covered at 100% by your insurance. However, you may want to call your insurance to see if you have limitations on these procedures. Some insurances will cover a comprehensive exam and full set of x-rays ONLY once every 5 years. This may cause you to end up with an unexpected bill after insurance payment has been processed.

Treatment Plans: Once you are seen in our office, we devise a treatment plan. We do our best to provide you with accurate estimates for your dental care by submitting your treatment plan to your insurance company, and asking them for a pre-treatment estimate. You should receive a copy of this pre-estimate directly from your insurance 2-3 weeks after it is sent via either email, mail, or an online portal (ask your insurance how they will communicate pre-estimates with you). If you schedule your treatment appointment before the treatment estimate is received, the estimate we give you for treatment may not be accurate, but it will be to the best of knowledge of what is typical of your plan. If you do not receive a treatment plan estimate from your insurance and you would like one for your upcoming appointment, please contact your insurance company. You can also give your insurance the ADA codes from the copy of your treatment plan and ask them over the phone how much you will be responsible for.  As your insurance company will highlight in the fine details, a pre-estimate is not a guarantee of payment and for unforeseen reasons, insurance companies may not pay what they say they will in the pre-estimate.  You are responsible to pay for any remaining balance after insurance pays or if insurance denies payment you are responsible for the full fee. It is then your responsibility to call your insurance company to inquire as to why they have not paid for your treatment.

We will submit the claim to insurance once, and will only re-submit for payment if we have made a billing error. If you did not provide us with correct information or your insurance has the incorrect information, you will need to pay the balance and then ask for reimbursement from your insurance company.

We make every effort to ensure you use the most of your insurance benefits. However if insurance denies coverage or does not pay in 60 days, you must pay the balance, and it is then your responsibility to call your insurance company to inquire as to why they have not paid for your treatment.

 

INSURANCE WORKSHEET

We have come up with a list of questions that you can ask your insurance company to be better prepared financially for your visit. We try to be transparent and help you navigate the complexities of your insurance coverage to help make the process as smooth as possible for you.

• NETWORK STATUS: Am I in or out-of-network with Dr. Soni/Dr. Mitko at Restoration Smiles? 
  1. If out-of-network→ Do I have out-of-network benefits?
  2. Many insurance plans will have the same coverage for patients who choose to see out-of-network dentists.
• WAITING PERIOD FOR NEW INSURANCE. If you recently obtained insurance you may have a waiting period of 3-6 months before you can use any benefits.
  1. Do I have a waiting period before I am eligible for benefits? _____
  2. Does the waiting period apply to diagnostic/preventative services (Exams/cleanings)? ______
• DEDUCTIBLES: Some insurances have a deductible of $50-500. This amount will need to be paid to us prior to any insurance benefits kicking in.
  1. How much is my deductible? _____
  2. Do I have to pay a deductible on preventative/diagnostic services (ie. exams/cleanings)? _____
• WILL I HAVE TO PAY FOR MY EXAM VISIT? Sometimes a comprehensive exam (the first exam at a new dental office) is only paid once every 5 years by insurance companies. Sometimes these exams are paid twice per year. How often are the following doctor exams paid?
  1. D0150 - Comprehensive Exam (1st visit at a new dental office) ___
  2. D0120 - Periodic Exam ___
  3. D0140 - Limited Exams ___
  4. Insurance companies may limit the number of exams you have per year. For example, if only 2 exams are covered per year and you have an emergency visit or a follow up exam, insurance may not cover the periodic exam at your next cleaning. How many exams are paid per year? ____
• WHITE FILLINGS. Our office only uses BPA-free white composite material for fillings. Many insurance companies only cover silver amalgam fillings (mercury-containing) for back teeth and they will downgrade reimbursement to the amount of a silver filling.
  1. Do you cover multiple-surface “white fillings” on back/posterior teeth? ____
• This is separate from a deductible. Rarely do insurances cover 100% of restorative treatment. You are usually responsible for approximately 10-50% of the cost. This is your co-insurance or copay.
  1. What is my copay for fillings? ____%
  2. For crowns? ____%
  3. For insert any procedure that you think you may need? ____%.
• INSURANCE MAXIMUM: Most insurance will have a cap on how much they will pay for annually. This can range from $500-$10,000. What is my individual insurance maximum for the year? _____How much has been used?____
• CODES FOR INITIAL APPT. I will be having an initial appointment with my new doctor and the following procedures will be completed at my first visit on such date______:
  1. A comprehensive exam (D0150)
  2. Full set of Intraoral x-rays (D0210)
  3. Panoramic x-ray (D0330) - if we need to evaluate any pathology or wisdom teeth
  4. Will these be covered? ______

You made it this far! Are you nauseated yet? Us too! We offer an affordable in office membership that can help you avoid the headaches of dealing with a third party insurance company. Ask about our Smile Club Membership!