Dental Insurance

We're Here To Accommodate You

Dental Insurance, Brea, California

For some, going to the dentist can sometimes inspire nervousness... not because of the procedures involved, but because of the costs! Gold Coast Dental Brea understands our patients' financial needs in these trying times. That's why we're proud to accept a wide variety of insurance plans -- all PPO (Preferred Provider Organization) insurance and most DHMO (Dental Health Maintenance Organization Plan) insurance. And if you're still hashing out your insurance situation, you've come to the right place. Here, we'll explain the ins and outs of dental insurance and hopefully provide you with a clear understanding of what's out there.

PPO Insurance Vs. HMO Insurance

What are they and how do they differ?

Because Gold Coast Dental Brea accepts all PPO plans and most DHMOs, you have some flexibility regarding what plan to choose. But what are the differences between PPOs and DHMOs? Let's take a closer look... PPO plans allow you to select any doctor or specialist to provide your care, whether they operate in or out of your network. With PPOs, you aren't required to choose a primary care physician (PCP) or come with referrals; if you want to see a specialist, the PCP does not need to speak with you first. As an extra feature for PPOs, if you require medical attention while you're away from home, you can choose any healthcare provider you wish. On the downside, PPO health plans involve higher out-of-pocket costs. Your monthly premiums will be higher,

as will your copays for doctor visits. On top of this, an annual deductible is required. One way to keep costs down is to stay within your PPO network when choosing a healthcare provider. For DHMOs, you are allowed to access certain doctors and hospitals within your DHMO's network. This is an interconnected group of providers that will lower their rates for members. Premiums are generally lower than you would find with PPO plans, and there is usually no deductible, or that amount is low. On the downside, there are often more restrictions on number of visits, tests, or treatments. Unlike with PPO plans, you may find that you are required to select a PCP, who will serve as your primary point of contact. If you see any doctor outside of your DHMO network, you will have to pay the full cost of their services.

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Why do I need dental insurance?

First, dental insurance helps you cover the costs of dental care, which can mount quickly, especially in emergency situations. Regular checkups and preventive care are also good ways to keep your overall dental costs down.
What is the best kind of dental insurance?

It all depends on your unique situation and your preferences. Delta Dental has a reputation for being the most well-rounded, while SmartSmile is known for being the cheapest. Humana, Ameritas, and MetLife are also held in high regard.
Does your office accept Medi-cal Dental?

We currently do not accept Medi-cal Dental, or Denti-cal, as it used to be called. However, there are plenty of other forms of insurance that we do accept!
How do I know if a dentist is in my network?

You can check the provider directory for each plan at the Office of Personnel Management. However, some of the records may not be up to date, so it's always best to check with your dentist directly.
What does dental insurance not cover?

Dental insurance rarely covers clear orthodontic services like Invisalign or highly cosmetic treatments like teeth whitening. It also does not often cover dental implants, though there is a higher chance that it would cover the crown on top of the implant.
What is a dental fee schedule?

A dental fee schedule is a list of prices detailing how much your dentist will charge for certain services versus what your insurance plan will pay. The insurance carrier will often base their fee schedule off UCR fees -- Usual, Customary, and Reasonable.
Am I able to keep my dentist?

Your ability to keep your dentist is determined by what plan you have. Indemnity plans and PPO plans would allow patients to continue seeing their preferred dentist. If you're with a DHMO plan, you must use a dentist who participates in your plan's network. Check to see whether your current dentist is part of that network.
How expensive is a dentist without insurance?

Several factors determine the cost of a dentist: the location, the service required, the inclusion of anesthetics, and the dentist's discretion, to name just a few. The fees can add up, so insurance is considered an effective way to defray the costs. However, many dentists offer in-house discount plans for patients without insurance. (We do, so make sure to ask us about ours.)
What is the difference between coinsurance and copayment?

A copayment involves a fixed dollar amount that you pay for each service you undergo. Coinsurance consists of paying a percentage of the total fee for the service. Copays usually do not count toward maximum out-of-pocket expenses, while coinsurance payments typically do.
How long does it take for an insurance claim to be fulfilled?

The amount of time it takes for a claim to be paid varies. At least 38 states have laws in place that require dental insurance carriers to pay their claims in a timely fashion, usually between 15 to 60 days.

Put Your Faith In Us

We offer excellence, integrity, and affordability

Going to the dentist shouldn't have to be a hassle -- especially if it's an emergency. Whether you're happy with your current insurance plan or you're still searching for the ideal one, we've got you covered (well, they do -- probably). If you're a cash patient, that's fine too! The type of insurance you have or don't have shouldn't be a barrier to receiving the best dental care there is to offer. If you have any questions or concerns about what kinds of insurance we support just give us a call at (562)356-0948 today.

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The Four Types of Dental Coverage

The 4 main categories of dental coverage available in the marketplace:

Preventive and diagnostic care: This includes tooth sealants, space maintainers, fluoride treatment, x-rays, cleanings, and examinations. Usually, for PPO insurance, about 70-80% of this bill is covered by your preferred provider, and sometimes even 100%, if the deductible is met. For DHMO plans, very little copayment should be expected.
Basic restorative dental services: These are generally up-front services that don't require significant laboratory expenses, like fillings, emergency dental care, root canals, tooth extractions, and crowns. PPO insurance generally covers up to 70-80% of these procedures, and DHMO insurance may require a copayment.

Major restorative care: This category includes treatments that are more complex and often require laboratory or specialist expenses, such as dentures, sedation, impacted wisdom tooth removal, implants, bridgework, onlays, and inlays. If the deductible is met, PPO insurance usually covers about 50% of these types of procedures, and DHMO insurance typically requires a copayment.
Orthodontia: This involves the use of devices like braces, retainers, and space maintainers to align the teeth, close gaps between teeth, preserve the position of teeth, or correct bite problems. Not all dental plans have coverage for this type of procedure, so you must check with your insurance provider.