we are Always updating our insurance plans.

please call us to find out if we work with your plan.

As part of our commitment to provide convenient and comfortable services to our patients, we accept Assignment of Benefits (we will obtain payment from insurance companies so patients are only responsible for Co-Pay, if any).

Our office is extremely experienced in dealing with insurance companies. We will do our best to ensure that our patients receive maximum benefits that they are entitled to under their insurance plans.   

Some major plans that we participate with are Aetna PPO, Delta Premier, Cigna Radius, and Assurant PPO. Please contact us for a complete list of plans and specific details about your benefits.


Dental Insurance Explained:

-The ABC’s of dental insurance at Leaf Dental

  •  Ask us for help! We are happy to answer all of your dental insurance questions.
  •  Before your appointment, please provide us with your dental insurance information so that we can verify your coverage.
  •  Copays are due at the time of service. We do our best to estimate your copays before each dental appointment and keep  surprises to a minimum.

-What’s Usually Covered in Dental Insurance?

Typically, a dental insurance policy will cover regular checkups and cleanings twice a year, although there may or may not be an out-of-pocket copay required for each appointment. Most dental insurance plans will also cover the majority of expenses related to cavity fillings.

In addition to check-ups and fillings, dental insurance should also cover part of the expenses related to annual X-rays, crowns, and other necessary repair work. However, it is possible that policyholders will be responsible for paying a deductible before coverage will kick in for these types of procedures.

-What’s Not Usually Covered in Dental Insurance?

While most dental plans cover basic dental work and preventative procedures, there are some procedures that many do not provide coverage for. A prime example of this is composite (tooth-colored) fillings.  Often, coverage will only be provided for amalgam (silver/mercury) fillings, and policyholders will be responsible for paying the difference between the amalgam fillings and composite fillings. Leaf Dental is proud to say that we are an amalgam/mercury free office!

Cosmetic procedures, such as tooth-whitening treatments, are also usually not covered by insurance. Other non-covered treatments may include:

  • orthodontic treatments (braces)

  • dentures

  • dental implants

  • dental care related to a medical condition

Of course, all dental insurance policies differ, so policyholders should contact a member of our team to discuss your unique dental benefits. We will be happy to assist!

 


DENTAL TERMINOLOGY

PPO Plan

with this plan, insurance companies set the fee that a medical/dental office must charge for certain procedures, and pay a set amount towards that fee. The difference is called the Patient Co-Pay. Patients are responsible for this amount.

within

a single insurance company, there may be various plans. The Patient Co-Pay depends on which plan the patient carries.

maximum

is the maximum dollar amount that insurance companies will pay for the subscriber's (patient's) dental care in one calendar or service year.

deductible

at the beginning of each new calendar year, depending on the insurance plan, there is a specific dollar amount that a patient must pay towards their care before the insurance company will pay any benefits.

Co-Payment

A cost sharing arrangement in which a member pays a specified charge for a specified service.

Amalgam

A common material used in fillings to repair cavities in teeth; also known as “silver fillings.” Dental amalgam is a mixture of silver, mercury and other materials.

Eligibility

The circumstances or conditions that define who and when a person may qualify to enroll in a plan and/or a specific category of covered services. These circumstances or conditions may include length of employment, job status, length of time an enrollee has been covered under the plan, dependency, child and student age limits, etc.

In-network/Out-of-network

Services provided in a plan either by a contracted or non-contracted dentist. In-network dentists have agreed to participate in a plan and to provide treatment according to certain administrative guidelines and to accept their contracted fees as payment. Different plans are served by distinct dentist networks.

Limitations and exclusions

Dental plans typically do not cover every dental procedure. Each plan contains a list of conditions or circumstances that limit or exclude services from coverage. Limitations may be related to time or frequency (the number of procedures permitted during a stated period) — for example, no more than two cleanings in 12 months or one cleaning every six months. Exclusions are dental services that are not covered by the plan.

Out-of-pocket costs

Any amount the enrollee is responsible for paying, such as coinsurance or copayments, deductibles and costs above the annual maximum.

Preauthorization

A requirement that recommended treatment must first be approved by the plan before the treatment is rendered in order for the plan to pay benefits for those services. Typically the approval process takes 3 weeks.

Waiting period

A stated period of time that a person must be enrolled in a plan before being eligible for benefits or for a specific category of benefits.


Feel free to contact our office if you have any questions about your dental insurance or payment options.

P: (718) 285-3035        E: LEAFDENTALTEAM@GMAIL.COM