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Answers to Your Dental Insurance Questions


At Sweet Tooth Care, we make sure our patients understand the treatments and insurance benefits. We understand that dental insurance is a confusing topic; but we are here to walk you through every step of the way from deductibles, to co-pay, to your insurance benefits. Let’s start with your insurance plan!


Insurance Plans

For starters, there are three categories of insurance plans that you could be under. HMO, PPO, and indemnity are all different insurance plans with varying benefits and drawbacks.

1. HMO (health maintenance organization): This insurance plan has the most payment coverage, but requires that you choose a dentist within the listed network of dental providers. If you decide to choose a dentist office that is not part of the limited HMO network, then your care will not be paid for by your insurance.

2. PPO (preferred provider organization): For PPO insurance, you have the freedom to choose any dental office you prefer. However, when you choose a dental office out of the network, you will have to pay more out of your own pocket than if you visited an in-network dental office.

3. Indemnity: With indemnity insurance, there is absolutely no list of network dental providers. You will have the same amount of coverage, regardless of the dental office. This insurance plan tends to be more expensive when compared to HMO and PPO plans.


Typical Benefits of PPO Insurance

As the most common insurance plan, PPO insurance offers yearly benefits that most people don’t fully utilize. Almost all dental PPO plans give you two FREE teeth cleanings and exams per year. This includes insurance companies such as Delta Dental, Guardian, Metlife, Cigna, and Aetna.

You can easily check your level of coverage for the different dental services with the typical 100-80-50 guideline.

100% of the cost of preventative treatments like teeth cleanings and dental exams is covered by your insurance. Almost all dental PPO plans give you two free dental checkups a year.

80% of the cost of restorative treatments like fillings and root canals is covered by your insurance. These are basic dental treatments to get your teeth back to great dental health.

50% of the cost for all major dental services like bridges and crowns is covered by your insurance.


How Sweet Tooth Care Helps You?

When you come to our office, we want to ensure that your understanding of your own insurance and payments equals ours. So here’s how we help with dental insurance.

1. Figure out all your specific benefits: Our financial coordinators assess your personal insurance plan to make sure you receive all the benefits possible from your insurance plan.

2. Tell you exactly what is and isn’t covered: We lay out all exactly what your insurance plan pays for and exactly what you pay out-of-pocket.

3. File the claims for you: If you would like to proceed with treatment, we deal with all your insurance claims for you, so you can focus on receiving the best service possible.

4. Follow up with insurance: If there are any problems whatsoever, we will do whatever it takes to make sure that you receive all of your insurance coverage.