Pricing & insurance made simple

Most of general dentists are in-network with many Cigna PPO, Aetna PPO, United Concordia Elite, and Premera Blue Cross plans. Effective March 15th, 2024 we are no longer scheduling new patients with Delta Dental plans. We also accept most major PPO plans like MetLife and Guardian. Not sure if your plan is accepted? Reach out to us and we’ll do a complimentary benefits check for you.

We are not currently participating in any Medicaid plans. We do not take Healthfirst, Metroplus, Fidelis, or United Healthcare community plans.

Yes, and it’s important to understand why. Unlike health/medical insurance, dental benefits are not meant to cover all oral healthcare needs. They are a financial benefit your employer purchases to help offset a portion of your care. Your coverage is based on what your employer pays into the plan, not on what your dentist recommends. Our NYC dental team will file claims and estimate your coverage, but any amount not paid by insurance remains your responsibility. We offer flexible payment options to help manage out-of-pocket costs.

Not always. Your insurance pays 100% of their allowable fee for that service. Not necessarily 100% of our office fee. For example, if your plan allows $170 for a dental wellness visit but our fee is $227, insurance pays $170 and you’d owe the remaining $57. As we process claims over time, we learn your plan’s allowable fees and can estimate your costs more precisely.

We use the most current information we have on your plan, including the benefits breakdown your insurer provides (e.g., 100% for preventive care, 80% for basic restorations, 50% for major work up to your annual maximum). Because these estimates don’t include exact allowable fees for every procedure, copayments collected upfront are always estimates. If insurance pays more than expected, we’ll issue a refund. If they pay less, we’ll send you a statement for the balance.

Frequency limitations restrict how many times per year your insurance will pay for certain treatments. But some patients may need a treatment more often to maintain good oral health. For instance, a plan may cover two dental cleanings per year, but some people, especially those managing gum disease, may need three or four visits. Additional visits beyond your plan’s limit are billed out-of-pocket. We always recommend making care decisions based on your oral health needs, not solely on what your insurance covers.

A deductible is the amount you pay out-of-pocket before your insurance begins to contribute. For example, with a $50 deductible, you pay the first $50 of covered treatment each year. Most plans waive the deductible for preventive care like cleanings and exams, meaning it typically only applies to restorative services like fillings or crowns. You only pay the deductible once per plan year, per patient.

A pre-existing condition is a dental issue that existed before your current coverage began. Many plans will not cover treatment related to pre-existing conditions.  For example, if a tooth was missing before your coverage started, your plan may not cover replacing it. Even if insurance won’t cover these conditions, treatment may still be medically necessary for your oral health.

Some insurance plans impose a waiting period (typically 6 to 12 months) before certain benefits become available. This means you and your employer must pay premiums for that period before you can use specific coverages. Preventive services like cleanings and exams are often available immediately, while restorative or major services may have a waiting period.

Think of your annual maximum as an insurance bank account that renews every year. All services, unless otherwise stated, get deducted from the maximum. Once you have exhausted the bank account, any other services must be paid for out-of-pocket. Unused dollars do not roll over into the next year, unless your plan has a special rollover account. Each member on the plan has their own annual maximum account. Most plans have an annual maximum of $1,000 to $2,000 a year to offset out of pocket costs, however you are still expected to pay all copayments and deductibles that may apply

PPO stands for Preferred Provider Organization. HMO stands for Health Maintenance Organization. Our office works with all types of PPO insurances because these plans allow you the freedom to choose any provider you’d like to see, whether they are in or out of network. We are in-network with many PPO plans.

We are not in-network with any HMO or DMO plans. These plans require that you choose an in-network dentist from a list of providers, and then see that specific provider for all your care. That’s because HMO/DMO dentists receive a check each month based on the number of patients assigned to him or her. HMO/DMO providers can be expected to perform services for a deeply discounted rate. On the other hand, PPO dentists only receive money from the insurance company if services are rendered.

Usually, patients who have an HMO/DMO plan will notice their choice of dentists is quite limited because fewer offices opt to participate in this kind of plan. However, out of pocket costs are generally lower with HMO/DMO plans than PPO plans, and have fixed co-payments. Having a PPO plan allows you to access a larger number of dentists providing higher quality care, but sometimes at a greater out-of-pocket cost. Additionally, if you have a PPO plan you can see a specialist without a referral, but if you have an HMO/DMO plan you usually need to obtain a referral before seeing a specialist.

Your coverage is determined by a contract between your employer and the insurance company, not by your dentist or what treatment you need. Employers choose which procedures to cover and at what cost-share level. If you feel your coverage is insufficient, we encourage you to speak with your HR department or benefits coordinator.

Yes, and it’s often the most accurate way to estimate your out-of-pocket costs before starting treatment. Keep in mind that pre-authorizations can take several weeks or months to process, and are still only an estimate subject to change. If your treatment is time-sensitive, we recommend proceeding while we estimate your coverage and settle up once insurance pays your claim, rather than delaying care to help a condition that that could worsen over time.

Absolutely. However, even though you may have two dental benefit plans, there is no guarantee that both plans will pay for your services. Some secondary plans will not pay until you have exhausted the entire maximum of your primary coverage. In most cases, even if both plans pay, the payments from all insurers will not add up to more than the total charges.

They can. Your employer has the ability to change the level of dental coverage at renewal, even if you have the same insurance carrier. Changes can affect your covered benefits, deductibles, annual maximums, or in-network providers. Please let us know anytime your plan changes or if you receive a new insurance card so we can update your records and re-verify your benefits.

Insurance companies use several tactics to reduce their costs, which can result in reduced or denied claims. Common reasons include: bundling (combining two separate procedures into one payment), downcoding (paying for a less expensive version of a procedure than what was performed), least-expensive alternative treatment (paying only for the cheapest treatment option rather than the one your dentist recommended), or a “not medically necessary” denial. If your claim is denied, we can assist you in filing an appeal, including a supporting letter, photos, and X-rays from your dentist.

The cost varies depending on the type of appointment. A routine dental wellness visit at our Upper West Side office typically includes a comprehensive exam, X-rays, and a professional cleaning. Our new patient special for that is $450. An emergency exam and x-rays is $199 for new patients. We offer flexible payment options to make care accessible regardless of insurance status.

We accept credit cards, debit cards, cash, and Care Credit. We also offer pay-over-time options to help people manage the cost of care.

Yes. We understand that some treatments like crowns, implants, or comprehensive care plans can represent a significant investment. That’s why we partner with two third-party financing providers, Sunbit and Lending Club, so people can break larger treatment costs into manageable monthly payments rather than paying everything upfront. Sunbit is known for fast, easy approvals with flexible terms, and is a great option if you need financing quickly. LendingClub offers longer-term financing plans for patients managing higher treatment costs. Both options are available to patients with and without dental insurance. Ask our front desk team about applying before your treatment begins. The application process is simple and typically takes just a few minutes.

Absolutely. We welcome patients with and without insurance. Patients without coverage pay our standard office fees, and we’re happy to provide a full cost estimate before any treatment so there are no surprises. Our team can also help you explore financing options.

Yes. We offer several ways to save on dental care at our Central Park West office. Seniors receive a 10% discount on treatment, and patients who pay their treatment balance in full at least seven days before their appointment receive a 10% prepayment discount. For the most savings, people enrolled in our Care+ Memberships  receive up to 20% off treatment. Please note that these discounts apply to out-of-pocket fees only and cannot be used in conjunction with in-network insurance benefits or combined with any other discounts. Call our office to learn more about which discount applies to your situation, or ask about joining Care+ when you book your next visit.