Insurance Policies And FAQs

Insurance Policies

For patients who have dental insurance, all service fees are outlined in advance in order to give you an estimate as to how much the treatment will cost. On the day of your appointment, a financial coordinator will review your benefit coverage and your financial responsibilities. Regardless of your dental insurance coverage, all balances incurred are your responsibility. Your insurance plan is a contract between you (or your employer) and an insurance carrier; in the event that an insurance claim is denied or only partially paid, Access Dental is not responsible for any balances remaining.

Deductible is a fixed dollar amount of health care cost that you must pay before your insurance will consider payment for your dental treatment. Individual and family deductibles are due at the time of your dental treatment visit.

Copayments are a shared cost that you have with your dental insurance carrier. Depending on the visit and specific service, you are required to pay a fixed dollar amount to the dental office.

Minors (children under the age of 18) must be accompanied by a parent or legal guardian (documentation will be required), who will be responsible for payments for any dental service that is done for said minor, at the time of the appointment. (Please note that any minor who arrives to an appointment without his or her parent or legal guardian, and who does not have a Consent Form on file, can be denied non-emergency treatment.)

If you or your dependent are treated as an emergency patient, all deductibles and copayments are due before services begins. For any non-emergency dental service that is not covered, or for which the office cannot verify coverage for a specific service, all fees must to be collected before any dental service is provided. Unless payment is made in advance, Access Dental may deny non-emergency treatment.

In the event that your account becomes past due and is sent to an outside collection agency or attorney, you will be responsible for all accrued collection/attorney fees.

For your convenience Access Dental offers Individual as well as Senior discount dental plans. By enrolling in our plans you can save 30% or more on almost all dental services. All enrollment fees and patient co-pays are due on or before your dental visit. There are no deductibles or claims forms necessary for these plans. Please contact your dental office for more information regarding our Individual and Senior plans.

What does Dual Insurance mean?

“Dual Insurance” refers to a patient with multiple dental benefits plan.

What is an Effective Date

Used to define the date that benefits begin for a plan enrollee.

Are there coverage limits?

Some services may have frequency limits, such as:

  • A limit on the number of exams, cleanings and bitewing x-rays that will be
    covered by the plan each year.
  • A limit on how often a full series of x-rays will be

  • covered by the plan each year. Time limits on the replacement of crowns, prosthetics (bridges, dentures, and implants).
  • A waiting period, or even an exclusion,may apply for the replacement of the teeth lost prior to coverage. Many dental plans include an alternate benefit provision. This means that if your dentist proposes a dental service, the plan may cover another lower-cost dental service that provides a professionally acceptable result for the issue being treated. You have the choice to receive the originally recommended service, which will increase your out-of-pocket costs. For example, under an alternate benefit provision, a plan may cover a:
    • Silver filling (amalgam) instead of the higher-cost composite resin (tooth-colored) filling on a back tooth.
    • Large filling (silver or white material) on a tooth instead of a full coverage crown. If you choose to have the “white” filling, you will pay the difference between the covered silver filling and the cost of the composite filling.
  • Dental plans may not cover every dental service that may be suggested by your dentist. For example, some plans may not cover implants. In addition, services for strictly cosmetic reasons, such as teeth whitening, are rarely covered by dental insurance. However, discounts for these services may be available at your dental office. The Office manager or Treatment Coordinator will be happy to discuss available discounts with you.

    Annual and Lifetime maximums

    An “annual maximum” provision is included in the majority of dental plans, and places a total dollar cap (maximum) on the amount of benefits to be paid out to an insured member during a single plan year. Once the plan’s maximum (e.g. $1,000 or $1,500) is reached, the plan will not make any payments until the first day of the next plan year. A yearly maximum could run on calendar year (January to December), or on a fiscal year, depending on the dental insurance company.

    Lifetime maximum refers to

    The cumulative dollar amount a plan will pay for dental care incurred by an individual enrollee or family (under a family plan). Lifetime maximums apply to specific services such as orthodontic treatment.

    Can you submit my insurance claims for me?

    Yes. But please remember, insurance coverage is a contract between the patient, employer, and insurance company or you and your insurance company. We will make every effort to assist in securing payment; however, as the patient, you are ultimately responsible for your account.

    Do you accept my insurance plan?

    Access Dental accepts most employer group dental PPO plans. These include but are not limited to: Delta Dental, Aetna, Cigna, MetLife, Premier Access, UFCW, and Blue Cross. We also accept State insurance programs such as Medi-Cal. Please call your local Access Dental office for more information. And remember, it is important that you understand your plan and what it covers. If possible, please bring a copy of your plan to your first appointment.


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