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.
Do you take my insurance?
We accept many major PPO dental insurances to make it easy and convenient to see a pediatric dentist in New York. Below is a list of the major PPO dental insurance companies that we are in-network with at Tooth Works Pediatric Dentistry, but accept many more. 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 insurance, you will most likely have out-of-network benefits and we will handle your claim and work with your insurance company to maximize your benefits. Call us for more information or visit our Office Policies section.
Delta Dental PPO
Empire Blue Cross Blue Shield PPO
Guardian PPO (select providers)
Direct Dental Administrators
What’s the difference between in-network and out-of-network?
In-network means that the participating dentist has agreed to utilize pre-negotiated rates set by the insurance company. Out-of-network means that the office will utilize their own fees and the insurance will reimburse based on your 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.
If my insurance is out of network with your office, does that mean I have to pay out of pocket first?
Not necessarily. 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, in which case full payment for services will be due the day of treatment.
What happens if my insurance company does not pay as they agreed to?
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.
Is there a way to get a more concrete estimate of how my insurance company will pay?
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 4 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.
Does Tooth Works offer payment plans?
Payment is due for services rendered at time of treatment, but in limited cases, a payment plan may be offered. A credit card authorization form will be completed with the scheduled payments as determined by the billing manager with an added service fee. This must be discussed prior to starting any treatment.
We also offer Care Credit in some cases which can be approved same day and can provide an option to pay over 6 months with NO added service fee. Tooth Works covers the service fee for you. Talk to our billing manager to see if you are eligible for this service.