Insurance Information
We understand that dental insurance can be very confusing, especially since it can differ widely from how medical insurance works. We’re here to help and answer your questions!
Below are some insurance and finance FAQs that may address your question you have. Please feel free to email or call us if your question is still not answered.
We accept many major PPO dental insurances to make it easy and convenient to see a pediatric dentist in Irvine. Below is a just a list (not complete) of the major PPO dental insurance companies that we are in-network with at Tooth Works Pediatric Dentistry, but accept MANY more. We may still be in-network with your insurance even if you do not see it on the list. Keep in mind – plans within these companies vary and we will confirm benefits for your specific plan prior to the visit. If your insurance is not on this list, give us a call to discuss further — we will obtain the necessary information and determine benefits. If we are out-of-network with your PPO plan, you may likely have benefits you can use at our office and we will handle your claim and work with your insurance company to maximize your benefits. We will contact your insurance co for those details before your appt. Call us for more information!
- Aetna PPO
- Always care (Unum/Starmount)
- Ameritas
- Anthem (most BCBS states)
- Blue Shield of CA
- Careington
- Cigna PPO
- Connection Dental
- Dental Network of America
- GEHA
- Guardian PPO
- Humana
- Lincoln Financial
- Metlife
- Principal
- United Concordia
- United Health Care
In-network means that the participating dentist has agreed to utilize pre-negotiated rates set by the insurance company. All treatment fees are dictated by the insurance co, not our office. Out-of-network means that the office will utilize our own fees and the insurance will reimburse based on your specific plan. If your plan provides out-of-network benefits you may not see a difference, but will depend on your plan. Many PPO plans provide out-of-network benefits that oftentimes do not differ from in-network benefits. We can easily check this for you using our system.
Not necessarily. If your insurance company sends our office the payment for services, then you only pay up front what your insurance plan deems as a co-pay or deductible for services. We will take care of the rest and work directly with your insurance company for payment. We process all claims for you.
In some cases, the insurance company will only provide reimburse to the patient (or will not provide us all the information), in which case full payment for services will be due the day of treatment.
You are ultimately responsible for the balance on the account whether it’s in-network or out-of-network. Although we work hard to obtain benefits prior to any visits, we cannot guarantee your insurance company will pay. The agreement for payment is a contract between you and your insurance company, not our office.
Yes! Most insurance companies allow us to send a ‘pre-determination’ claim once we know what services will be required to determine the payment they will make (unless treatment is started at another office). This can typically take 2 weeks. Alternatively, you can call directly with the codes and they may provide you with exact payment. However, this method may not provide solid documentation as a pre-determination can. Regardless of a pre-determination being sent, the insurance co will always state that it is still not a guarantee of payment. You are still ultimately responsible for the balance on the account.
We have options! We offer an in-house membership plan suited for your child’s specific age and needs. Click HERE to see details of the plans we offer. You can also reach out to us at any time for Q’s.
We also offer payment plans in limited situations of large treatment plans. This must be discussed prior to starting any treatment and may not be eligible for those on a membership plan. We utilize Care Credit for all payment plans which can be approved same day and offers a NO interest and NO service charge 6 month payment plan (when installments are made in a timely manner). Tooth Works covers the service fee for you. Talk to our office manager to see if you are eligible for this service or for more information.