Insurance Coverage for Patients

• We are an Out-of-Network Provider: We work with most employer-provided insurance plans as a non-participating (out-of-network) provider. This means we can submit claims to your insurance on your behalf, but we do not have negotiated, in-network rates with these plans.

• Maximizing Your Employer Benefits: We will do our best to help you make the most of the benefits your employer has provided. However, final coverage and payment are determined solely by your plan, which is why we encourage you to verify your benefits before treatment.

Insurance Providers 

• Aetna Dental Plans
• Blue Cross Blue Shield of Arkansas Federal
• Blue Cross Blue Shield of Massachusetts
• Blue Cross Blue Shield of New York (Syracuse)
• Careington Care PPO
• CIGNA
• Corporate Benefit Services of America (now Meritain Health)
• DDIC
• Delta Dental of California
• Delta Dental of Colorado
• Delta Dental of Illinois
• Delta Dental of Massachusetts
• Delta Dental of Minnesota
• Delta Dental of New York
• Delta Dental of Pennsylvania
• Delta Dental of Washington
• Delta Dental of Wisconsin
• Empire Blue Cross/Blue Shield
• GHI – New York (Group Health Inc.)
• Guardian Life Insurance Co. of America
• MetLife
• Solstice
• Sunflower State Health
• United Concordia Companies, Inc.
• United Healthcare

What insurance policies do we not accept:

We DO NOT accept Medicaid/ Healthfirst.
We DO NOT accept HMO or DMO insurance

Cash patients with a first-time appointment which includes Prophy, Fluoride and Exams will need to be paid upfront.

We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. At no time do we guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance.

We currently do NOT accept the following Insurance Claims Providers

1. Medicaid
2. Healthfirst

Our aim is to make your kids dental visit as stress-free, quick and seamless as possible.

Before your child’s appointment, and at our discretion, we recommend that you verify your dental insurance coverage to ensure a smooth and efficient visit. It’s important to confirm your benefits and notify understand if any co-pays, deductibles, or out-of-pocket expenses that apply.

To help expedite this process, we also recommend that you provide us with your insurance information when scheduling the appointment. 

This will help avoid any surprises on the day of the visit and ensure that your child receives the best care possible.

Please note: We do not have specific information on Insurance provider coverage as each persons policy can vary significantly and any policy information, claims and benefits are not accessible by us, and must be confirmed by the patient / patients parents prior to treatment. 

• • We Submit Claims for You: If we have all your insurance information on the day of the appointment, we’ll electronically file your claim as a courtesy.

• • Estimated Portion: We will collect from you the estimated amount not covered by your insurance. Please remember this is only an estimate, not a guarantee.

• Insurance’s 30-Day Window: By law, your insurance company is required to pay each claim within 30 days of receipt. If you do not receive payment or an Explanation of Benefits (EOB) within that time, we encourage you to follow up with your insurer.

We Accept the following payment methods:

1. Cash/Zelle
2. Credit Cards
3 Debit Cards
4. HSA

Navigating dental care costs can be complex, but we are dedicated to offering straightforward and flexible financial options for your family. Whether it is understanding insurance benefits or exploring payment alternatives, our aim is to make the process clear and convenient for you.

Recognizing the needs of families without insurance benefits, we are proud to offer our Smile Assurance Plan. This in-house plan is tailored to make pediatric dental care in New York City, NY, more affordable, allowing you to manage dental expenses while ensuring your child receives essential dental care.

To find out more about this policy, please contact our head office. 

Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment. At no time do we guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance.

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company. A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100.00, or $80.00. Out of a $150.00 fee they will pay an estimated $80.00 leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.