Insurance for Dental Procedures in Durham
WE ACCEPT DENTAL INSURANCES!
If you have dental insurance (PPO) and can choose your own doctor , we may be able to file your insurance as a courtesy to you. Please check with our office prior to your visit to verify that we can file with your insurance company: H&L Dentistry Phone Number (919) 213-0505 .
H&L Dentistry remains in-network only with Delta Dental Premier Insurance until March 31st, 2025.
We are an out-of-network provider for all other commercial/private dental insurances available. This means that we will submit your dental insurance claim as a courtesy to you and collect your co-pay , if any, for services provided.
Patients are ultimately responsible for payment of all rendered services, no matter what the insurance coverage may be. Remember; your dental insurance is a contractual agreement between you and your insurance company. For detailed information about insurance coverage for dental services, contact your insurance company directly to the number on the back of your card. Call our office and we’ll help you in any way we can. For privacy reasons some insurances do not disclose that information to anyone but the patient directly.
Frequently Asked Questions About Insurance or Payments
What does in-network mean? It refers to when an office or dentist has established a contract agreement with a dental insurance company. The contracted provider receives a flow of new patients in exchange for accepting all the insurance company’s terms.
Other dentists chose to work as an out-of-network provider and not being limited by contract terms that affects or hinders optimal patient care. In other words, these out-of-network dentists are not contracted directly with an insurance company but they can accept and process your insurance and send your claims directly. Usually, in most dental insurance policies, preventive routine care (such as cleanings, checkups and x-rays) is covered at 100% for both out-of-network providers and in-network providers. This depends on the policy that has been selected by the employer who provides the insurance to the patient.
Why should I chose an out-of-network dentist?
- The main benefit of opting for an out-of-network dentist is that you are free to choose the doctor you feel most comfortable with. When you value your oral health, you don’t want to choose a dentist from a very limited list of names. You certainly don’t want to make a hasty decision. Not only because you would like to get the best professional treatments, but also because you want to feel in safe hands.The choices you have on the list of in-network providers are much more limited than those out-of-network. Typically, you will choose a dentist after talking to your friends or family, or by doing a little research on the web. Online reviews and word-of-mouth will surely help you find a reliable dentist. And most often you will be able to find this dentist out-of-network.
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No downgrading. In-network dental providers are usually subject to limitations on the types of treatment or procedures that will be covered by insurance. For example, an in-network dentist might be limited to offering only silver (amalgam) fillings or metal crowns on back teeth, which do the job, but are not as aesthetically pleasing as white resin (composite) fillings or natural-looking porcelain/ceramic crowns. Such stipulations by insurance companies are called “downgrades,” and they are not an issue when you go to an out-of-network dentist.
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“Out-of-network” does not mean no insurance accepted. On the contrary, most out-of-network offices do accept many different insurance plans, so long as they are PPO plans. PPO plans allow you to choose both in-network and out–of-network providers. Most insurance companies offer these Preferred Provider Organization plans to give insurers more flexibility.
The possibility of choosing out–of-network, and the reimbursement benefits are part of these PPO plans. This means that if you choose an out-of-network dentist who accepts your insurance plan, you can still get coverage and benefits. H&L Dentistry can file the claim, and help you with the reimbursement process.
Payments vary according to the nature of the treatments you get. Preventative services are usually covered 100%, while restorative or cosmetic treatments have a small co-pay.
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Another main benefit of choosing out-of-network: you are free to look for the most skilled professionals, and get the best quality treatments. When you are free to choose your dentist, you are free to evaluate aspects such as;
- the doctor’s expertise
- the years they’ve been in practice
- the technology they use
- the elements and materials they use
- the dental labs they work with
- safe protocols
All these elements have to do with the quality of the services you get. Getting high quality treatments is important because it will prevent you from spending more money or getting more complex treatments in the future.
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Still-affordable treatment A common misconception with going to an out-of-network dentist is that the cost will be too high to afford since it’s out of pocket. This turns out to only be true for a surprisingly small number of insurance policies Just because there is no downgrading required, and insurance policies won’t cover as much of the total costs, that doesn’t mean that out-of-network dentists are out of reach financially.
Most of the time, going to an out-of-network dentist will not reduce your maximum annual benefits, and insurance companies will cover the same amount of the fees that they would do for an in-network dentist. In other words, many policies will cover a certain amount, based on what they consider is “reasonable and customary,” and then you are required to pay the remaining balance.
As an example, insurance would cover 100% of a procedure that costs $300 at an in-network dentist, or it may cover $275 of the procedure from an out-of-network dentist because that is the “reasonable and customary” price. You’d still have to pay the balance, but not at full price—and you’d have the added benefit of seeing the dentist of your choice.
Will I have to file my own insurance claims at an out-of-network dentist? No. This is another big myth that some new patients come in with. As with most things dental insurance companies do, filing is a complicated process. In our office, we have a member of our team who does it all day. She knows the lingo and how to get it done efficiently and correctly. When you come in as a new patient, we’ll take a look at your insurance, explain your benefits and, after your appointment, file your insurance for you.
Medicare: If you have medicare and you have been issued a dental insurance card, we may be able file claims for you. Please contact our office for more info.
Medicaid: We do not accept medicaid insurance at the present time.
FSA/HSA Accounts: We accept this form of payment if the card has a Visa/Mastercard logo and can be processed as such.
CareCredit® : We do not participate in CareCredit. If you have it and your card has a Visa or Mastercard logo on it we may be able to take it as payment. Call our office for more information.
Payment Forms: We accept all major credit cards, checks and secure electronic payments such as Apple Pay™.
Video: Insurance and Dental Services
If you have any questions regarding your account, please contact us at our Durham office: H&L Dentistry Phone Number (919) 213-0505. Many times, a simple telephone call will clear misunderstandings.
