Dental Insurance

Encino Boutique Dentistry accepts MOST dental PPO plans.
Our office does not accept HMO, denti-cal, medi-cal.

Dental insurance works great to help prevent or maintain dental conditions, but dental insurance can be limited. Please understand your policy limitations and benefits. Our office verifies dental coverage before the first visit, but verification of coverage is not a guarantee of coverage. The more information provided to us, the better we can catch any issues with coverage. Dr. Mogharabi diagnoses conditions and recommend treatment based on clinical data, expertise, and visual exam. Although Dr. Mogharabi does not recommend treatment dictated by insurance limitations, our office does take each patient’s situation into account when discussing treatment options. There are ways to maximize coverage and get the most out of your dental plan. Dual coverage (spouse covers spouse), health savings accounts, care credit financing and supplemental plans like AFLAC dental, are some additional ways to help cover costs of treatment.

How Dental Insurances Work

Employer-based dental PPO or Union benefits: dental plan pays dental office directly for services rendered. Patients pay a 0%-75% co-pay depending on service.

Verifying Benefits

Our team knows that verifying benefits and having accurate benefit details is very important.  Insurance companies have made the process more efficient via the web, but they also limit specific details, limits, and exclusions. Always try to receive as much information about your plan directly from your insurer.

Yearly Maximum

Each patient has a set yearly dollar maximum in coverage. For example, insurance companies can pay $1,000 - $3,000 per year on a dental plan. Depending on the insurance plan, coverage can either begin at the beginning of the calendar year (i.e. January 1st) or at the beginning of the benefit year (when the policy plan becomes effective). Each year, the plan renews but amounts unused are not lost and do not roll over. 

Yearly Deductible

Deductibles range from $25-$100 per year and are applied to basic, restorative, and major procedures. Deductibles are applied to the first treatment of the year and include treatments such as fillings, crowns or deep cleanings. Dental insurance deducts the amount of deductible from the claim payment, which is added to the patient's total out of pocket cost. In some cases, there is no deductible such as exams and x-rays. 

Coverage

Dental plans pay a percentage of a negotiated fee for a particular service. Offices that are in-network with a dental plan discount their private fee and only agree to charge the patient a set price for a procedure, and any portion not covered by the plan.

Frequency of coverage

Although most people are not familiar with the details of their dental coverage, 'two cleanings per year' seems to be the number one benefit people know of and an example of the frequency of covered benefits. Dental plans allow for two cleanings anytime in a calendar year or two cleanings separated by six months. For example, a dental plan will only pay towards a filling on a single tooth, every 24 months, and every five years for a crown. Each plan has their frequency, limits, and rules -- some are not like others. 

Orthodontics

Orthodontic benefits are a separate lifetime maximum usually equal to the yearly maximum. Even though a patient seems to have orthodontic coverage included in a plan, an age limit may often exclude the patient from benefits. 

Dual coverage

Spouses can be covered under each other's dental plans if available. What one plan does not cover, the other plan will cover. Rules and details related to dual coverage are changing, so make sure to ask your HR about coordination of benefits if you are interested in adding your spouse to your dental plan.

Open Enrollment and switching to PPO

Open enrollment happens once or twice a year depending on the company and is the time to upgrade your dental plan, add a spouse or dependent, and sign up for a health savings account. Health savings account (HSA) is when pre-tax dollars are set aside to help cover out of pocket medical or dental expenses. The patient pays with a special visa/MC and provides their company with receipts. Not every provider offers this, but it is used here at Encino Boutique Dentistry. 

HMO plans seem only to benefit the insurance company, and most people come to realize that quickly. More providers are dropping HMO plans from their practices making it difficult for HMO patients to find a dentist. Quality of care is a grave problem as HMO patients are promised zero or significantly lowered out of pocket fees. HMO plans do not make up the difference, leaving the provider to cut corners, overbook their schedule, and charge patients for extra services. If you have an option to choose dental plans, always select a PPO plan.