Insurance Information Chatsworth, CA

Please don't hesitate to contact your insurance provider for information on your coverage and costs. If you need help, our team is available to assist you. Just give us your carrier name and subscriber ID, and we can help you understand your benefits.

Our office may not have a direct contract with your insurance provider if you are out of network, but that does not mean we do not accept your insurance. For carriers with whom we have a direct contract, we offer in-network fees. When you are out of network, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to determine your responsibility. We accept major PPO insurances but are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

Dental insurance operates similarly to other employer-provided insurances like Medical and Vision. Typically offered through employers, it involves monthly premiums, preferred providers, and benefits guidelines. One notable distinction is that dental insurance has an annual maximum reimbursement limit, whereas medical insurance begins covering expenses once an individual reaches their out-of-pocket maximum.

Dental insurance is similar to medical insurance, but with a key difference: the insurance provider covers up to a set amount within a benefit period, typically a year. Any costs beyond this limit are the patient's responsibility. The maximum allowable amount varies depending on your insurance plan and is important to know when considering costly treatments. Dental PPO plans categorize services into preventive, basic, and major, each with its own coverage percentage. For example, many PPO plans cover 100% of preventive services, 80% of basic services, and 50% of major services. However, these percentages are specific to each plan, so it's essential to understand your coverage by reviewing your personal benefits. Any expenses not covered by insurance must be paid by the patient.

Dental insurance typically covers a range of dental procedures such as exams, cleanings, fillings, crowns, oral surgery, and orthodontics. These services are categorized as preventive, basic, and major, with coverage percentages predetermined and the patient responsible for the remaining costs. Orthodontic coverage is different, with age restrictions, limitations on beneficiaries, and lifetime maximums rather than annual limits.

A PPO, or "preferred provider organization," allows you to choose your own dentist without needing a primary dentist. You can see specialists without a referral, but staying in-network can save you money. This is different from HMO/DHMO plans, which focus on affordable dental care with little to no copays through a designated primary dentist or facility. With HMO/DHMO plans, you must choose a primary dentist and usually can only see specialists with a referral.

PPO plans usually cover two exams and cleanings per calendar year.

In many instances, yes. Nevertheless, it's essential to be aware of any exceptions and regulations before seeking care. For example, a dental implant might not be covered if your insurance plan includes a "missing tooth clause" and you were previously missing the tooth. We can assist you in obtaining information regarding the specific rules applicable to your coverage.

In many cases, yes. However, orthodontic treatment is distinctive and often subject to regulations concerning age eligibility, covered beneficiaries, and maximum benefit amounts. Typically, orthodontic coverage entails a lifetime maximum rather than an annual limit. We can assist you in obtaining information about the specific rules that apply to your coverage.