Understanding Dental Insurance

No. Dentistry at East Piedmont is out-of-network with every dental insurance carrier. That's a deliberate choice. Staying out-of-network lets us spend the time, use the materials, and deliver the experience our patients expect, without an insurance company dictating the standard of care. If your plan has out-of-network benefits, we file your claims for you as a courtesy.

It's a deliberate choice. Staying out-of-network lets us spend the time, use the materials, and deliver the experience our patients expect, without an insurance company dictating the standard of care. The experience at our practice is what it is because of that choice.

Call or text us with your insurance card handy. We make every effort to get an accurate estimated portion in advance and walk you through that. Insurance estimates are just that, though. They are estimates, not a guarantee of coverage. The binding answer always lives in your policy with your carrier.

Insurance is a contract between you and your carrier, not between us and your carrier. Carriers often don't share the full details of your specific plan with the practice. We make every effort to get an accurate estimated portion in advance, but the binding answer always lives in your policy documents and your carrier's customer service line. The more familiar you are with your own coverage, the fewer surprises there are. Your policy is the source of truth.

Your annual maximum is the most your dental insurance will pay in a single benefit year. The exact cap varies by plan and is typically the hardest constraint on what insurance contributes to a larger treatment plan. Once your insurance has paid out that maximum, your coverage ends for that benefit year, and any additional care is out of pocket until the new benefit year starts. The exact maximum and benefit year reset date are in your policy documents, and we verify both before any treatment begins.

A deductible is the amount you pay out of pocket before your insurance starts paying its share. Most dental plans have a small annual deductible, usually 50 to 100 dollars, that resets at the start of each benefit year. Preventive care such as cleanings and exams usually doesn't require the deductible to be met first. General and restorative care typically do. We collect your deductible at the visit if your plan applies one. Your exact deductible amount is in your policy documents.

A waiting period is the time you have to be enrolled in a dental plan before certain procedures are covered. New plans often include a 6 to 12 month waiting period for major services like crowns, bridges, or implants, even if those procedures are technically included in your benefits. Preventive care such as cleanings and exams usually has no waiting period and is available right away. Your specific waiting periods are spelled out in your plan documents.

A missing tooth clause means your insurance won't cover the replacement of a tooth that was already missing before your current coverage started. If you lost a tooth before you signed up for the plan, the plan often excludes coverage for replacing that specific tooth, including crowns, bridges, and implants. Many plans include this clause; many don't. Your policy documents will spell out the exact language.

A frequency limitation caps how often your plan covers a particular service. The most common example is two cleanings per benefit year, six months apart. Other limits can apply to X-rays, fluoride, and some restorative work. If you've already had a service this year and need it again sooner, the second one usually becomes out of pocket. Your specific limits are spelled out in your policy.

A pre-determination is when we submit your treatment plan to your insurance ahead of time and ask what they expect to cover. There's a catch. Carriers are not obligated to honor a pre-determination. They can issue one, then pay a different amount when the claim comes in. We find them highly unreliable for that reason. If you want to know what your plan will actually pay, you're better off calling your carrier directly. We'll give you the ADA codes from your treatment plan. You read them off to the carrier and ask for estimated coverage on each. The answer you get directly from your carrier carries more weight than a pre-determination on paper.

Your estimated portion, based on your specific plan. We calculate that ahead of time so the number isn't a surprise. The total fee we quoted you is the fee. We stand behind that quote.

The fee we quoted you doesn't change. If your insurance ultimately reimburses less than estimated, the difference becomes your responsibility. We work through payment options with you once the claim settles.

No. Cosmetic procedures aren't covered by dental insurance, in-network or out-of-network. That's industry-wide, not a Dentistry at East Piedmont rule. We're upfront about it so there are no surprises, and we partner with reputable third-party financing so the investment is manageable. Most patients qualify for flexible monthly payment plans.