Dental Insurance and Financial Information

Important insurance statement

Dental insurance is an agreement between the patient, subscriber, employer, and insurance company. Gentle Dentistry of Poway can assist with verification and claim submission when applicable, but the insurance company makes the final decision about eligibility, coverage, frequency limits, downgrades, exclusions, and payment.

An estimate is not a guarantee of benefits.

Before your appointment

Provide complete and current information:

• Insurance carrier
• Exact plan name
• Member ID
• Group number
• Subscriber name and date of birth
• Employer information when required
• Information about secondary coverage

Tell the office immediately when coverage changes. A carrier name alone is not enough to confirm network participation because the same company may offer many different plans and networks.

Understanding common plan terms

Deductible

The amount a patient may need to pay before the plan begins paying for certain services.

Annual maximum

The most the dental plan may pay during a benefit year. It is not the maximum cost of dental care.

Coinsurance

The percentage assigned to the patient and plan after applicable deductibles and limitations.

Frequency limitation

A rule limiting how often a service may be covered, such as an examination, cleaning, X-ray, crown, or other procedure.

Waiting period

A period of time before certain benefits become available.

Alternate benefit or downgrade

A plan may calculate payment using a lower-cost alternative even when the patient and dentist choose a different treatment.

Pre-treatment estimate

A request sent to the insurance company for an estimate of potential benefits. It is not a promise of payment and may not account for claims processed later.

Payment responsibility

Patients are responsible for charges not paid by insurance, including deductibles, coinsurance, non-covered services, amounts beyond an annual maximum, and services affected by plan limitations.

Before treatment, the office can provide an estimate based on the information available. Final responsibility may change after the insurance company processes the claim.

In-house dental savings plan

Gentle Dentistry of Poway promotes an in-house dental savings or loyalty plan for patients who want an alternative to traditional dental insurance. The plan may include defined preventive services and savings on eligible treatment.

The in-house dental savings plan is not dental insurance.

Plan details, current pricing, enrollment terms, and whether the savings plan can be combined with insurance are confirmed by the practice. Contact the office at (858) 485-8420 for the current plan information.