Dr. Orfaly and his team create dental treatment plans in ways that maximize insurance benefits and are the most affordable for you.
We work hard to stay current with changing insurance filing and coverage requirements. At Fisher & Orfaly Dental, we accept most dental insurances that are available. We are Delta Dental, Blue Cross Blue Shield, Cigna, and Altus providers.
We know your smile is a valuable investment.
The way in which dental insurance works, is often confused with other insurances. While most dental procedures are covered by insurance, we recognize that every dental insurance is different. A traditional insurance plan is designed to set up to cover the loss and the insurer bears the risk. Whereas, dental insurance covers most of the cost of specified treatments.
Generally, dental policies cover some portion of the cost of preventive care, fillings, crowns, root canals, and oral surgery, such as tooth extractions. They might also cover orthodontics, periodontics (the structures that support and surround the tooth) and prosthodontics, such as dentures and bridges. You’re usually covered for two preventive visits per year. This means bi-annual dental cleanings and dental exams.
Most plans follow the 100-80-50 coverage structure. That means they cover preventive care at 100%, basic procedures at 80%, and major procedures at 50%, or a larger co-payment.
Dental procedures at most insurance companies are grouped into 3 parts: preventive, basic, and major.
Crowns & Bridges: Dental crowns and bridges are restorative treatments that affect the patient’s oral health. So, most insurance companies will fully cover the cost of the dental crown treatment and cover major portions of the dental bridge treatment.
Root Canal: The cost of root canal treatment will depend on the extent of the infection. Most insurance companies will cover at least part of the cost of root canal therapy.
Dentures: Major insurance companies will cover the partial or full cost of the treatment, depending on your plan. Usually, insurance will cover up to 50% of the cost of dentures.
Fillings: The full or the partial cost of cavity fillings may be covered by insurance, depending on your plan.
Mouth guards: Mouth guards are a preventative measure. So most dental insurances will cover the full or partial cost of customized mouth guards made by dental professionals.
Usually, cosmetic procedures are not covered by insurance. A procedure is considered to be cosmetic if:
The procedure exists solely for enhancing the aesthetics of the patient’s smile.
The underlying tooth or tissue is not injured, impaired, or decayed.
There is no medically necessary reason for altering the tooth or performing the procedure.
The following procedures are not covered by most dental insurance plans:
However, these procedures can be financed by CareCredit.
We understand that everyone has unique dental needs. We will treat you based on your needs not allowing the insurance company to influence your health. Fisher & Orfaly Dental offers a 12-month interest-free payment plan through CareCredit.
It is important to know what benefits are covered under the dental plan. Here are some commonly used dental insurance terms:
This is the total amount of money that your insurance plan covers.
This means a percentage of charges you have to pay. For example, if you have a 70/30 plan, then your insurer will pay 70% of the cost and you are supposed to pay the balance 30%.
It is an amount you are required to pay before your insurance plan starts to pay. Most dental plans do not require that you pay a deductible for any preventive or diagnostic services, however, you can verify your plan as each plan is unique.
Your budget shouldn’t stop you from getting a healthy mouth. So we accept a variety of dental insurances, payment choices, and financing options that fit your wallet.
Major Credit Cards (Visa®, MasterCard®, American Express®, Discover®)
Third-Party Credit Cards and Financing Options e.g. CareCredit
All Major Insurances
Payment arrangements for account balances are due at the time services are rendered, so please bring your insurance card with you to your first visit. You can also speak with our office administrator about flexible payment options available for major dental services.
Dr. George Orfaly, of Fisher and Orfaly Dental, explains why it is important to maximize your dental insurance coverage and use all the benefits available to you as soon as possible in this blog.