GENERAL INFORMATION

We are participating providers of Delta Dental of Washington (and most other Delta plans), Premera Blue Cross Insurance Company, Guardian Insurance, and United Concordia Insurance. We are happy to electronically bill any insurance company for you (regardless of whether we are a member or not), and we will take utmost care to research your individual dental benefits; however, we cannot guarantee what your insurance company will pay. We will give you an estimate of your personal financial responsibility before treatment is begun and work with you to find a payment option that will fit your budget.

No dental insurance or need help making your co-payment? We all need a little help from time to time; let us work with you to find a way to afford dental treatment. We offer several different options, and most of our patients find one or more of these plans will accommodate their budget. Give us a call, set up an appointment, or stop by and let us explore the options with you.

INSURANCE OVERVIEW

Do you have dental insurance? Have you tried reading your benefit booklet and come up with more questions than answers? The magnitude of various dental plans available is enough to make your head hurt, and then there is always the fine print. Together, we can pour over the details of your individual plan. We can make a few phone calls to ask more specific details about your dental benefits and obtain a general breakdown of your benefits. Bring us your insurance booklet and/or dental insurance card and we will begin the research for you; we are here to help.

FAQ

Does my insurance guarantee what they will pay?

There are so many variables with insurance coverage (i.e. deductibles, maximums, alternate benefit clauses, waiting periods—just to name a few) that all estimated copayments we calculate are truly ESTIMATED. We base the quote we give you for your copayment off the information your insurance company gives us. Each conversation with your insurance starts with a disclaimer: “They DO NOT GUARANTEE any information.” We give you our honest interpretation of the information they share with us.

Why do I have a copayment when my insurance states they pay 100%?

The percentage your insurance company states they will pay is off their fee schedule, which may or may not match our charges. Each insurance company can have its own fee rate called a usual customary rate (UCR). Each dental insurance plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed, and cost of living. Each insurance company may also have a separate UCR for each employer they cover.

What is the missing tooth provision?

The missing tooth provision means that if you have a tooth missing when you start your current dental insurance coverage they will not cover the cost of replacing that tooth, whether through a bridge, denture, or other prosthetic.

Are there individual dental insurance plans available?

If you are not able to participate in a group plan (usually through an employer) there are individual plans available. We have a brief list of companies, but an insurance broker could give you a more complete selection. Each one has its own benefit limitations, so read the fine print carefully before enrollment. Call to make an appointment to review the information on the plans you are interested in, we are glad to help you interpret their level of benefits.

What is the difference between a copayment and deductible?

If your insurance doesn’t pay for all of the treatment, the copayment is the cost you are responsible for.

The deductible is the amount you must satisfy before your insurance company will begin paying benefits. The amount of the deductible, if your plan has one, is dictated by the benefit package you have.

How do I determine my yearly maximum and/or calendar year?

An annual maximum is the maximum amount your dental plan will pay in benefits during the calendar year or plan year. Most companies select calendar year, which is January 1 through December 31; however, some select a plan year that corresponds to when their group's benefits renew (or open enrollment). Some employers use a dental benefit program that runs from month to month, based on the number of hours you work. There are many variables when it comes to insurance companies and the benefits they offer. It is very important to know your dental benefits and when they renew. We gladly offer our assistance in understanding your dental plan.

Why does my benefit period or calendar year matter?

Once your insurance company has paid benefits totaling the benefit maximum, they will not pay any additional benefit dollars until your next benefit year begins.

Is orthodontic treatment considered part of my dental maximum allowable?

If you have orthodontic coverage, some dental plans have a separate policy for those benefits and some include it in the general dental coverage.

WEB SITE LINKS

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Clinical FAQ
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Dental Sleep Therapy of Walla Walla
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Oral Systemic Health Information
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mouth. The health of your mouth does matter—read more
American Dental Association
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Orofacial Pain Information
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