Dental Insurances
Making Sense of Your Benefits at Alcoma Dental
At Alcoma Dental, we understand that dental insurance can sometimes feel confusing. Every insurance plan is different, and understanding deductibles, annual maximums, coverage percentages, and network restrictions can be overwhelming.
Our goal is to make the insurance process as simple and transparent as possible while helping you make informed decisions about your dental care.
Your Dental Insurance Is a Benefit
Dental insurance is designed to help with the cost of dental care, but it does not necessarily cover the entire cost of treatment.
Your insurance benefits are determined by the specific plan you have through your employer or insurance company. Coverage can vary based on the procedures performed, your plan’s limitations, your remaining annual maximum, deductibles, and whether your dentist is in or out of network.
Most importantly, your insurance company—not Alcoma Dental—determines your benefits and what it will pay.
What Does Dental Insurance Typically Cover?
Many dental plans divide services into three general categories:
Preventive & Diagnostic Care
Routine examinations, cleanings, X-rays, and other preventive services. These services are often covered at a higher percentage.
Basic Services
Fillings, periodontal procedures, and other basic treatments. These services are typically covered at a lower percentage than preventive care.
Major Services
Crowns, bridges, dentures, oral surgery, and other more extensive procedures. These services often have lower coverage percentages and may be subject to additional limitations.
Every plan is different, so your specific benefits may vary.
Understanding Your Deductible
A deductible is the amount you may have to pay before your insurance begins paying toward certain covered services.
For example, if your deductible is $50, you may be responsible for the first $50 of applicable treatment before insurance benefits begin.
Some plans do not require a deductible for preventive services.
Your Annual Maximum
Many dental insurance plans have an annual maximum, which is the maximum amount your insurance company will pay toward covered dental services during your benefit year.
For example, if your annual maximum is $1,500 and your insurance company has already paid $1,500 in benefits, you may be responsible for the cost of additional treatment for the remainder of that benefit year.
Unused benefits generally do not roll over unless your specific plan provides a rollover benefit.
Because dental benefits can expire, we encourage our patients to be aware of their benefit-year dates and remaining coverage.
What Is Coinsurance?
Coinsurance is the portion of a covered service that you are responsible for after any applicable deductible.
For example, if your plan covers 80% of a particular procedure, you may be responsible for the remaining 20%.
Keep in mind that insurance percentages are generally based on your insurance company’s allowed or negotiated amount, not necessarily the actual fee charged by the dental office.
In-Network vs. Out-of-Network
Your insurance plan may provide different benefits depending on whether you visit an in-network or out-of-network provider.
An in-network dentist has agreed to specific fees with an insurance company or network. An out-of-network dentist may not have the same contractual agreement.
Depending on your plan, choosing an out-of-network provider could result in:
- A lower insurance payment
- A higher out-of-pocket expense
- Different deductibles or reimbursement levels
- Limited or no coverage for certain procedures
At Alcoma Dental, we are happy to help you understand how your benefits may apply to your treatment.
Insurance Estimates Are Not Guarantees
When possible, Alcoma Dental will obtain an estimate of your insurance benefits before treatment. However, an insurance estimate is not a guarantee of payment.
Insurance companies may change benefits, apply plan limitations, process claims differently than expected, or determine that a procedure is not covered.
Your insurance policy is a contract between you, your employer (when applicable), and your insurance company. Alcoma Dental is not a party to that contract.
Ultimately, the patient is responsible for any balance not paid by insurance.
Our Commitment to You
At Alcoma Dental, we believe that your treatment should be based on your dental health—not solely on what your insurance company chooses to cover.
Our team will recommend treatment based on your individual needs and will work with you to provide information about estimated costs and insurance benefits whenever possible.
We will submit insurance claims on your behalf when applicable and assist with the insurance process, but we cannot control how an insurance company ultimately processes or pays a claim.
Your Smile. Your Health. Your Choice.
Dental insurance can help make quality dental care more affordable, but it should never determine whether you receive the care you need.
Our team at Alcoma Dental is here to help you understand your benefits, plan for treatment, and make decisions that are right for you and your oral health.
If you have questions about your dental insurance or a treatment estimate, please don’t hesitate to ask our team. We’re here to help.
Dental Insurance Plans We Work With:
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In-Network Status: United Concordia PPO Aetna PPO Aetna Medicare Careington Serviced Plans Colonial Life PPO Delta PPO GEHA PPO Guardian PPO Humana PPO Medicare HMO SunLife PPO UPMC Dental Advantage UPMC for Life Medicare WPEE |
Out-of-Network Status: Cigna PPO Dentemax Serviced Plans Metlife PPO |
We do not take: DHMO plans Medicaid plans (including UPMC for You, Highmark WholeCare, Gateway, etc.) Government Assistance Plans |
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We are here to help! Please call for more information about financing your oral health needs in our office!