We understand that dental insurance can be confusing. We’re happy to work with you to navigate the challenging maze of your benefits. We’ve compiled the following information to help you. As always, please do not hesitate to speak with any member of our team. You deserve complete and effective treatment. We’re dedicated to working with you to ensure you receive the care you need and the results you want.

DO I NEED A REFERRAL? IS THERE AN AGE RESTRICTION WITH MY INSURANCE PLAN? WHAT ELSE DO I NEED TO KNOW?

Many plans have requirements when it relates to your visit and processing your claim.  Because Cavity Busters is a pediatric specialist group, there could be some limitations with certain plans. Below is a list of those plans and their limitation:

•  Aetna DMO - a referral is required from a primary dentist for the first visit ONLY. Patients can only be seen up to the age of 7.  Once the child turns age 7, they can no longer be treated with this insurance plan at our offices.
• Cigna DHMO - patients are eligible up to the age of 13.  Once the child turns age 13, they can no longer be treated with this insurance plan at our offices.
• Concordia Plus -  a referral is required from a primary dentist for every 6-month check-up to the age of 7.  Once the child turns age 7, they can no longer be treated with this insurance plan at our offices.
• Delta Care USA -  a referral is required from a primary dentist. Patients can only be seen up to the age of 8.  Once the child turns age 8, they can no longer be treated with this insurance plan at our offices.
• Delaware Valley 1776 - a referral is not required. Patients can only be seen up to the age of 4.  Once the child turns age 4, they can no longer be treated with this insurance plan at our offices. 
• Dominion DHMO - a referral is required from a primary dentist for every visit  up to the age of 7.  Once the child turns age 7, they can no longer be treated with this insurance plan at our offices.

DENTAL BENEFITS

We accept most dental insurance plans. We only ask that you carefully read your policy to be sure that you are fully aware of any restrictions that apply to the benefits provided. Dental insurance is a contract between the patient and the insurance company for reimbursing the cost of dental services. It is not a contract between the dentist and the insurance company. 

No insurance, no problem!  We are happy to schedule your visit and review any fees associated with treatment.

Your dental insurance may not cover all the dental care you need. Sometimes, a dental plan will only pay for the cheapest treatment, even when this is not the most effective solution. Relying primarily on dental plan benefits can have an impact on the overall success of your treatments. We want you to be able to receive the care you need to maintain optimal dental health without restrictions or limitations.

In addition, we’d like to remind you:

• Dental benefits typically cover only a portion of the costs for more advanced procedures. 
• Cosmetic treatments, like tooth whitening, are usually not covered by dental insurance.
• Typically, dental insurance will pay for two cleanings a year. If you do not use these benefits by the end of your benefit period, you will lose them. We encourage you to take advantage of this benefit!
• Sometimes, a dental plan will only pay for the cheapest treatment---even though this may not be the most effective treatment. Please speak with our team so you can have all the information you need to make an educated and well-informed choice.
• Please review your plan to understand your coverage. This may mean speaking with an insurance representative or your human resource benefits department.
•  Participation in an insurance plan is not required for you to receive treatment at our practice.

THE CLAIMS PROCESS

After your visit, we will submit a claim to the insurance plan on your behalf with the completed procedures. The plan will either pay the claim in full or apply a deductible and/or co-pays for any non-covered procedures. We will try to estimate what the costs will be during the check-in process and will request those fees be paid when the services are rendered that day.  After submission of the claim to your insurance plan, you will receive an Explanation of Benefits (EOB) from showing your benefit coverages.  If there are any additional fees after processing the claim, we will send you a statement for payment.