Insurance

To learn what they are and how much they cover, you may always contact your insurance provider. Our Middle Creek Family Dentistry insurance experts, however, may perform a check and provide you with a detailed breakdown. Your subscriber ID and carrier name are all we require.

In many cases, out-of-network benefits provide full coverage for preventative care. Middle Creek Family Dentistry and your insurance consider your checkups and cleanings preventative! We'll let you know exactly what is covered and how much you'll owe after receiving your information.

Simply put, being out of network means that Middle Creek Family Dentistry has no formal agreement with your insurance company. No, it doesn't imply that we won't accept your insurance. They have negotiated costs for those carriers with whom we do have direct contracts. To determine what you will owe when out of network, we apply the coverage percentages that correspond to your out-of-network benefits to the base price for the service.

Dental insurance operates under the same fundamental principles as other employer-provided insurance plans like medical and vision. The majority of dental insurance is provided by your company, comes with monthly fees, has restrictions on who you can see, and offers a variety of benefits. The main distinction between medical insurance and dental insurance is that the former covers reimbursement after the insured person has reached their own out-of-pocket maximum, while the latter only does so up to a yearly maximum.

The main distinction between dental insurance and medical insurance is that the former is responsible for "First Money Out," which means that they will pay up to a "Maximum Allowable" amount during a given benefit period (typically a year), and the latter will be the patient's responsibility for any amount that exceeds that cap. Your insurance plan's Maximum Allowable Amount is distinct, and it's crucial to understand it before requesting more expensive medical care. Dental PPO plans often cover services based on ranges or categories: Preventive, Basic, and Major. This is similar to how Medical Co-Insurance works. For instance, the majority of PPO plans offer 100% coverage for preventive care, 80% coverage for basic services, and 50% coverage for major procedures. As this breakout is customized to a certain plan, you must speak with your insurance provider. The patient is responsible for everything that their insurance does not cover.

Dental insurance usually includes all sorts of dental treatment, from routine cleanings and exams (often twice a year), through simple procedures like fillings and crowns, as well as oral surgery and orthodontics. Each type of care is divided into preventive, basic, and major services by insurance companies, and each is covered to a certain extent (the average breakdowns for the coverage percents are 100%, 80%, and 50%). When it comes to orthodontics, there are usually restrictions regarding age, who can use your insurance, and the amount that is covered (i.e. there is a lifetime max versus and annual amount).