Insurance FAQs Insurance demystified.

Dental insurance works very differently than medical insurance. In many cases the maximum that dental insurance will pay any given year is no more than $1,000. For patients who have treatment needed, dental insurance is usually just a coupon. True insurance is regular cleanings, examinations and x-rays. Prevention is the better value!

Please read our most common insurance questions and answers below. If you still have questions, give us a call 404-255-2273 or shoot us an email at insurance@dentaltlc.com

What type of dental insurance plans do you accept?

We are able to accept most dental insurance plans as long as they are PPO Plans (Preferred Provider Option, this means you have Out-of-Network benefits and do not have to pick off of a list of providers). Unfortunately, we cannot accept HMO, DMO, discount plans, or Medicare plans, but we would still be delighted to see you in our office.

What does PPO mean?

PPO is short for preferred provider option. This means you can choose to see any dental professional that you desire. Other plans limit who you have the ability to see for your dental care, which hinders us from accepting them.

How can I know what my dental insurance benefits are?

We are always happy to do a complimentary insurance benefits check for you prior to your appointment.

Is my medical and dental insurance the same?

Medical and dental insurance are different. They may be handled by the same insurance company, but they are two completely different policies. The best way to be sure is to contact your human resources department to clarify who your dental insurance provider is.

What information do you need to verify my benefits?

To verify your benefits we need the name and phone number of your insurance company. We also need the name of the employer or group the insurance is provided under, the legal name of the policy holder and their social security number, date of birth, and member identification number. We also need the patient’s legal name and date of birth. For your personal security, we cannot check on your benefits without this information and this information is securely shredded following the benefits check *Please note that if you have MetLife dental insurance, we will also need the zip code that they have on file for you to check on your benefits.

What insurance companies are you in network with?

We are currently in network with most Blue Cross Blue Shield of Georgia, Delta Dental Premier, and Aetna PPO plans.

My dental insurance plan is out of network; will that mean that I have to pay more?

In most cases with dental insurance, in network and out of network benefits are typically very similar, especially for preventative and diagnostic services. In-Network just means that we have agreed to charge less fees to the insurance company for services. Most patients with Out-of-Network benefits who come in for their regular cleaning, exam, and x-rays have minimal or no out-of-pocket costs for their appointment.

Do you guarantee what the insurance company says they will pay?

The insurance company is only provides us with an estimate of coverage. They can change fees and processing guidelines at any time and have different rules that affect what services they cover based on each individual patient. We are happy to submit a Predetermination for services that are not preventative and diagnostic to give you a more accurate estimate of your benefits. We are unfortunately unable to guarantee any payment on services due to the insurance companies’ rules and regulations.

My plan is In-Network, but your in-house Periodontist is out of network; what does that mean?

For your convenience, we have a full time Periodontist on our staff. The services our Periodontist provides are specialty services and use your Out-of-Network benefits. It is the equivalent to you visiting your regular doctor and them referring you to a specialist; we just make it more convenient for you by having the Periodontist here in our office.

I’m presently shopping for new dental insurance. What should I look for?

When you are looking for dental insurance, it is best to speak directly with someone at the insurance company. Online searches are limited in some of the information they provide and you want to ensure that you get the best benefits for your dental needs.

Important questions to ask insurance companies.

  • Is the plan on a fee schedule? If the plan is a fee schedule, this means the insurance company will almost always pay less for services, even if you are seeing an In-Network provider. For example, they may pay 100% of $5 for a cleaning that costs $90 and you are stuck paying the remaining $85.
  • Does the plan have a waiting period? If the plan has a waiting period, this means that you have to wait to get certain services performed. For example, they may have a 12 month waiting period for a crown which means that you have to wait one year from the day you signed up for the policy before the insurance company will help pay for it. So, if you want the crown sooner, you would have to pay the full amount for your crown.
  • Is there a missing tooth clause? If the plan has a missing tooth clause, this means that the plan will not pay to replace missing teeth. For example, if you wanted an implant or bridge to replace a missing tooth, the insurance company would not pay to replace it if it was extracted prior to the start date of the coverage. The full cost for the implant or bridge would be your responsibility.
  • Does the plan only cover preventive and diagnostic services? If the plan only covers preventive and diagnostic services, this means that they will only have coverage for your exam, basic cleanings, and x-rays. These plans tend not to have coverage for fillings and will not have coverage for periodontal cleanings, root canals, crowns, bridges, and implants. For example, if you needed a filling, the insurance company would not cover it so you would have to pay the full amount out of pocket.