You can always check with your insurance company to find out what they are and how much they cover. However, the Tend insurance team can check for you and give you an exact breakdown. All we need is your Carrier name and subscriber ID.
In many instances, out of network benefits cover preventative services at 100%. Your exams and cleanings are considered preventive by Tend and your insurance! Give your info and we’ll tell you exactly what is covered and how much you’ll owe.
Being out of network simply means Tend does not have a direct contract with your insurance provider. It does not mean we don’t take your insurance. We take all insurances except DHMOs, Medicaid, Healthplex, and Emblem. For those carriers that we do have a direct contract with, they have negotiated prices. When out of network we use the base price for the service and apply the coverage percentages that correspond to your out-of-network benefits to calculate what you’ll owe.
The basic premise of dental insurance is the same as other types of employer-provided insurances such as Medical and Vision. Most dental insurance is provided by your employer, has monthly premiums associated with that coverage, has guidelines on who you can see, and differences in benefits provided. The major difference with dental insurance is that the insurance provider has a yearly maximum they will reimburse, whereas a medical insurance provider covers reimbursement after the individual reaches their own out of pocket maximum.
Dental insurance works similarly to your medical insurance, with the main difference that the Insurance provider is responsible for “First Money Out”, meaning they cover up to a “Maximum Allowable” amount in a given benefit period (usually a year) and the patient is responsible for any amount over that limit. The Maximum Allowable amount is unique to your insurance plan and is important to know what it is when seeking more expensive care. Further, as with Medical Co-Insurance, Dental PPO plans typically cover services based on ranges or categories: Preventive, Basic, and Major. As an example, most PPO coverages provide 100% coverage for Preventive services, 80% coverage on Basic, and 50% for Major. This breakout is plan-specific and you will need to consult your personal benefits to understand your coverage. What is not covered by your insurance is the patient’s responsibility.
Typically, dental insurance covers all types of dental care ranging from exams and cleanings (typically 2x / year), basic dental care (fillings, crowns, etc.) to oral surgery and orthodontics. Insurances categorize each type of care into Preventive, Basic, and Major services and each is covered at a determined percentage, leaving the remaining balance to the patient (typical breakouts are 100% / 80% / 50% for the coverage percent). Orthodontics are unique and typically have rules around age, who on your plan is allowed to use, and how much is offered (i.e. there is a lifetime max versus an annual amount).
A PPO is a “Preferred Provider Organization”. PPOs do not require you to choose a primary dentist, although one is recommended. You don’t need referrals to see specialists, either, but you will save money if you see one in your plan’s network. These differ from DHMO insurance plans that typically cover dental services at a low cost and minimal or no copayments with a pre-selected primary care dentist or a dentist facility with multiple dentists. You are required to select a Primary Dentist and are restricted to that Dentist unless otherwise referred to a specialist
In most cases, two exams and cleanings in a calendar year.
In most cases, yes. However, there are exceptions and rules that are important to know prior to cre. For instance, an implant would not be covered if you were previously missing your tooth and your coverage includes a “Missing Tooth Clause”. At Tend, we can tell you what rules are in place for your specific coverage.
In most cases, yes. Orthodontics are unique and typically have rules around age, who on your plan is allowed to use, and how much is offered (i.e. there is a lifetime max versus an annual amount). At Tend, we can tell you what rules are in place for your specific coverage.
It is generally recommended to have dental examinations every six months. Regular dental check-ups allow your dentist to evaluate your oral health, detect any issues early on, and provide preventive care to maintain a healthy smile. However, the frequency may vary depending on your individual dental needs and your dentist’s recommendation.
Teeth whitening involves using bleaching agents, usually containing hydrogen peroxide or carbamide peroxide, to remove stains and discoloration from the teeth. The bleaching agent breaks down the color compounds on the enamel, resulting in a brighter and whiter appearance. Teeth whitening can be performed by your dentist in-office or using take-home kits with custom trays.
Dental implants are considered a long-term solution for missing teeth and can last a lifetime with proper care. Implants consist of a titanium post that is surgically placed in the jawbone, acting as an artificial tooth root. A dental crown or prosthesis is then attached to the implant, providing a stable and natural-looking tooth replacement. While the crown may require replacement over time, the implant itself is designed to be a permanent fixture in the mouth.
General dentistry focuses on preventive, diagnostic, and basic restorative dental care to maintain oral health. This includes routine check-ups, cleanings, fillings, and gum disease treatment. On the other hand, cosmetic dentistry primarily focuses on improving the appearance of teeth and smiles. Procedures such as teeth whitening, veneers, and dental bonding fall under cosmetic dentistry. While there can be overlap between the two, the main difference lies in the primary objective of each field.
Root canal therapy becomes necessary when the dental pulp, which contains nerves and blood vessels inside the tooth, becomes infected or inflamed. This can occur due to deep decay, repeated dental procedures on the tooth, cracks, or trauma. Root canal therapy involves removing the infected pulp, cleaning the root canals, and sealing them to save the tooth from extraction and eliminate pain or further infection.
Dental crowns, also known as caps, are used to restore and protect damaged or weakened teeth. They cover the entire visible portion of the tooth above the gum line, providing strength, durability, and aesthetics. Crowns can be used to restore teeth with extensive decay, cracks, fractures, large fillings, or after root canal therapy. They can also be placed on dental implants to replace missing teeth.
Restorative dentistry involves the diagnosis, prevention, and treatment of oral health issues to restore the function and aesthetics of the mouth. It includes procedures like fillings, crowns, bridges, dentures, and dental implants. The goal of restorative dentistry is to repair or replace damaged or missing teeth, improve oral health, and restore a natural-looking and functional smile.
Some signs of a dental emergency include severe tooth pain, facial swelling, excessive bleeding, a knocked-out tooth, a loose or dislodged tooth, or a dental abscess. If you experience any of these symptoms or have concerns about sudden changes in your oral health, it’s important to contact your dentist promptly to assess the situation and determine if immediate dental care is required.
Common oral surgical procedures include tooth extractions (including wisdom teeth), dental implant placement, bone grafting, corrective jaw surgery (orthognathic surgery), gum grafting, and treatment of oral lesions or tumors. Oral surgeons are specialists trained to perform these surgical procedures in a safe and effective manner.
Full mouth reconstruction is a comprehensive treatment approach that involves restoring the entire mouth, addressing multiple dental issues simultaneously. It combines various restorative and cosmetic procedures tailored to an individual’s needs, such as dental implants, crowns, bridges, veneers, and orthodontics. Full mouth reconstruction can improve oral health by restoring functionality, enhancing aesthetics, and resolving bite problems, ultimately leading to improved chewing ability, speech, and overall oral health.
The benefits of dental treatments vary depending on the specific procedure, but in general, they aim to improve oral health, restore function, enhance aesthetics, and alleviate pain or discomfort. Risks associated with dental treatments are typically minimal but can include temporary sensitivity, allergic reactions, or complications related to anesthesia. Your dentist will discuss the potential risks and benefits of any treatment before proceeding and will take necessary precautions to ensure your safety.
Dental implants offer several advantages over other tooth replacement options. They provide a stable and durable foundation for prosthetic teeth, function like natural teeth, and help preserve jawbone density. Implants do not rely on adjacent teeth for support, preserving their integrity. Additionally, implants can enhance speech, improve chewing ability, and provide a more natural-looking and aesthetically pleasing smile compared to other alternatives like dentures or dental bridges.