Insurance

We often receive inquiries about whether we 'take' or 'accept' patients' insurance. At West Maple Dental, we are equipped to accept any Preferred Provider Organization (PPO) dental benefit plan that allows you to choose your dental provider. For those with a PPO plan, we can manage claims and accept benefits on your behalf. While we strive to maximize your insurance benefits whenever possible, our practice is not solely driven by insurance considerations. Instead, we prioritize your dental health and well-being. Our treatment recommendations are based on your individual needs rather than the limitations of insurance plans. We are committed to collaborating with you and your benefits plan to achieve your oral health objectives.

A dentist designated as an 'In Network' provider has entered into a contractual agreement with an insurance company. In this arrangement, the dentist agrees to offer services at discounted rates in exchange for being recognized as a 'preferred provider' by the insurance carrier. This benefits the insurance company by reducing their expenses on dental claims and ensures a steady flow of patients to the dentist's practice.

Conversely, an 'Out of Network' provider has not entered into such a contract with an insurance company and is not bound by their fee structure or restrictions. This grants both the patient and the dentist greater flexibility in making decisions regarding dental care, as they are not constrained by insurance company regulations.

While many of our patients rely on dental insurance to assist with treatment costs, we prioritize transparency regarding our contracted relationships with insurance carriers. While in-network providers may offer potentially lower out-of-pocket expenses, this isn't always the case. In fact, we often find that patients' out-of-pocket costs remain similar regardless of network status. It's important to recognize that not all insurance plans are alike; some may offer better coverage than others. Prior to any dental procedures, we provide detailed treatment plans with estimated costs, ensuring full clarity for our patients. Should you have any inquiries regarding our practice's contractual status with your insurance provider, please don't hesitate to reach out to us for clarification.

The maximum limit of a dental plan refers to the highest amount an insurance company will reimburse for claims within a specific benefit period. While this period typically aligns with the calendar year, it may also follow a fiscal or plan year starting in a month other than January. Most dental plans cap the maximum benefit at $1,000 per covered individual per year. Unfortunately, these maximums have remained stagnant for decades, and significant treatments can swiftly deplete this allowance. Moreover, due to busy modern lifestyles, many patients fail to utilize their dental benefits before they expire or are terminated, resulting in loss for the patient and gain for the insurance company.

A dental plan's deductible signifies the amount the patient must pay out of pocket before their insurance coverage initiates. Typically, deductibles apply solely to basic and major services and exclude preventive treatments like exams and cleanings, although exceptions exist. In certain plans, deductibles may encompass certain x-rays or all preventive and diagnostic services. Once the deductible is met, the insurance company begins to cover a percentage of eligible services.

Insurance companies often implement various rules and restrictions to limit their payment obligations for treatments. These may include service frequency limits, waiting periods, clauses regarding missing teeth, and alternative benefits provisions. Familiarizing yourself with the details of your policy documents is advisable to understand these constraints. These rules are negotiated between your employer and the insurance company and are contingent upon the selected plan's quality.

Our doctors diagnose and provide treatment based on what you need, not based on what your insurance covers. Some employers or insurance plans exclude coverage for necessary treatment to reduce their cost. If you’re having trouble affording your dental care, ask us! We offer financing options if the procedure allows, we can sometimes spread out treatment a little to help you afford it.

We offer third party financing through Care Credit, which is a healthcare credit card that allows you to finance treatment costs anywhere from 6-24 months.

We know navigating dental insurance options can be difficult, which is why we endeavor to explain all costs involved with your treatment plan upfront. We want you to feel comfortable with every aspect of your experience at our dental practice.

We're delighted to provide CareCredit, the premier patient payment program in the nation, as a service to our patients. CareCredit allows you to finance 100% of your procedure with no upfront costs, annual fees, interest, or pre-payment penalties. This means you can conveniently schedule your procedure today and make low, interest-free monthly payments.

• 12 month plan

• For treatment fees $300 or more

• Interest free

• Low Monthly payments

CareCredit functions as a revolving credit line for repeat procedures, eliminating the need for re-application. Applying for CareCredit is quick and easy, taking only a few minutes, and you may receive an online decision in seconds!

For more information or to apply now, visit www.carecredit.com.