Clayton Family Smiles accepts and submits to many dental insurance plans, but we may not be considered “in network” for your particular insurance. Give the office a call with specific questions.

The best way to find out if your dentist is “in network” is to go to your dental insurance’s website and do a provider search. Clayton Family Smiles submits to many insurances but in order to get the most out of your dental insurance plan, you may want to see a provider that is in your network.

You can always go to the dentist of your choice. The question is whether you will have benefit coverage for the treatment you receive if it is provided by a dentist who is not on the plan’s list. This depends on contractual agreements between the plan purchaser (often your employer), the dentists on the list and the plan administrator. Under certain contracts, such as a PPO (Preferred Provider Organization) program, patients are given a financial incentive to go to certain dentists but do receive some level of dental benefit, regardless of the treating dentist. Other plans, such as capitation programs, do not provide any benefit coverage for treatment given by “non-participating” dentists. In all instances where this type of plan is offered, patients should have the annual option to choose a plan that affords unrestricted choice of a dentist, with comparable benefits and equal premium dollars.

It is common for dental plans to exclude some treatments, especially if they are covered under the company’s medical plan. Some plans, however, go on to exclude or discourage necessary dental treatments such as sealants, pre-existing conditions, adult orthodontics, specialist referrals and other dental needs. You should be aware of the exclusions and limitations but should not let those factors determine your treatment decisions. Unlike your insurance carrier, your dentist always has your best interest in mind and is going to recommend treatment that is vital to your oral health.

This information should be provided by your plan purchaser (your employer or union) and by the third-party payers. The extent of benefits available should be clearly defined, with limitations described, and the application of deductibles, copayment and coinsurance factors explained. This should be communicated before having any treatment done.

The plan document should also specify who is eligible for coverage under the plan and when that coverage is in effect.

Your dentist cannot answer specific questions about your dental benefit or predict what your level of coverage for a particular procedure will be. The best thing to do is to ask your insurance carrier to answer specific questions about coverage. For larger treatment plans, we recommend doing a “pre-authorization” with your insurance carrier prior to having any work done.