Insurance and payment
Dental insurance, in plain words.
We're in network with ten major PPO dental plans, we check your benefits before treatment, and if you don't have insurance there's a simple yearly membership and two ways to pay monthly. Here's how it all works at our Oak Lawn office.
- In network
- 10 PPO dental plans
- No insurance
- Sunshine Membership, $119 a year
- Pay monthly
- Sunbit or Cherry
- First visit
- $89 exam, x-rays and consult
Which dental insurance plans do you take?
We're in network with the PPO dental plans below. In network means the insurance company and our office have agreed on fees ahead of time, so your share of the bill is usually lower than it would be at an office outside the network.
- Delta DentalPlan guide
- AetnaPlan guide
- Blue Cross Blue ShieldPlan guide
- CignaPlan guide
- DentamaxIn network
- GuardianIn network
- HumanaIn network
- MetLifePlan guide
- United ConcordiaIn network
- UnitedHealthcareIn network
Five of them have their own page with plan-specific tips: Delta Dental, Aetna, Blue Cross Blue Shield, Cigna and MetLife. Don't see your plan? Ask anyway. Many PPO plans still pay part of the cost when you see a dentist outside their network, and we'll tell you honestly what to expect before you book.
How do dental benefits usually work?
Most dental PPO plans sort care into three buckets and pay a different share of each. The exact percentages are set by your employer or your plan, so read these as typical ranges, not promises.
Preventive
Exams, cleanings and routine x-rays. Many plans pay most or all of this, often twice a year. It's the part of their benefits people most often leave unused.
Basic
Fillings, simple extractions and, on many plans, root canals and gum treatment. Plans commonly pay a large share, often somewhere around 70 to 80%, after your deductible.
Major
Crowns, bridges, dentures and, on some plans, implants. Plans often pay around half, and some have a waiting period before they pay anything toward major work.
Cosmetic treatment like whitening and veneers is usually not covered. Orthodontics, including Invisalign, depends entirely on the plan: some include it with its own lifetime limit, many don't.
Annual maximums, deductibles and waiting periods
Five words do most of the work in a dental plan. Here's what each one means for your wallet.
Annual maximum
The most your plan will pay in one benefit year. Once it's used up, you pay the rest until the year resets. Many plans reset in January, but some follow your employer's plan year.
Deductible
What you pay yourself before the plan starts sharing costs on basic and major care. Many plans waive it for preventive visits.
Waiting period
A stretch after you enroll before certain care is covered. It's more common on plans you buy yourself than on employer plans, and usually longest for major work.
Frequency limits
How often the plan pays for something, like two cleanings a year or a full set of x-rays every few years. You can still have the care sooner, it just may not be covered.
Coinsurance
Your share of the bill after the deductible, like 20% of a filling. It's figured from the in-network fee, which is one reason staying in network usually costs less.
Timing matters too. If you're close to your annual maximum, or your benefits are about to reset, it can make sense to split treatment across two benefit years. When it's safe to wait, we'll point that out.
How we check your benefits before treatment
Nobody likes a surprise bill, so we look before we treat. Here's the order it happens in.
Send us your plan
Text a photo of the front and back of your card, or call with the member ID and the name of the person the plan is under.
We verify
The front desk checks that the plan is active, and looks at your remaining maximum, deductible, frequency limits and any waiting periods.
You see the numbers
Before treatment, we go over what the plan is expected to pay and what your part is likely to be, in English or Spanish.
Bigger work gets a pre-check
For crowns, implants and other larger treatment, we can ask your insurance company for a predetermination first, so the estimate comes from the plan itself.
An estimate is our best reading of your plan. The final amount is set when the claim is processed, and if anything comes back different, we'll walk you through it.
No insurance? The Sunshine Membership
If you don't have dental insurance, or your plan barely covers anything, the Sunshine Membership is our own in-house plan. One yearly fee of $119, no insurance company in the middle and no claim forms.
- Two exams with x-rays every year
- Unlimited emergency exams
- 20 to 30% off treatment, depending on the procedure
Certain conditions apply. Ask the front desk for details.
It tends to make the most sense if you want regular checkups, you're planning treatment in the next year, or you'd like a safety net for the tooth that suddenly starts hurting. Ask the front desk what the discount looks like for the treatment you have in mind before you join.
Can I pay over time?
Yes. For treatment you'd rather not pay all at once, we work with two financing companies. Both split the cost into monthly payments, and applying takes a few minutes.
Sunbit
Monthly payment plans for treatment, with a quick application at the front desk or on your phone.
Cherry
Another monthly payment option, handy for splitting larger treatment into smaller payments.
Terms depend on the plan you're approved for, and some options may come with 0% interest. You'll see the monthly amount before you agree to anything. Financing works alongside insurance or the membership, so you can use it for the part your plan doesn't cover.
Getting the most out of your plan
- Use your preventive visits. They're usually covered well, and they catch small problems while they're still small.
- Know your reset date. Unused benefits generally don't carry over, so a visit late in the benefit year can be worth it.
- Tell us about a second plan. If you're covered by your own plan and a spouse's or parent's, both may pay part of the bill.
- Ask before big work. A predetermination takes some of the guessing out of crowns, bridges and implants.
- Keep your card current. If your job or plan changes, send us the new card before your next visit.
Questions