Insurance Information
Toms River, NJ

Please don't hesitate to contact your insurance provider for information on your coverage and costs. If you need help, our team is available to assist you. Just give us your carrier name and subscriber ID, and we can help you understand your benefits.

Our office may not have a direct contract with your insurance provider if you are out of network, but that does not mean we do not accept your insurance. For carriers with whom we have a direct contract, we offer in-network fees. When you are out of network, we use the base price for the service and apply the coverage percentages corresponding to your out-of-network benefits to determine your responsibility. We accept major PPO insurances but are not contracted with Denti-Cal, Medi-Cal, or HMO plans.

Dental insurance works in a similar way to other employer-provided insurances such as Medical and Vision. It is usually offered through employers and includes monthly premiums, preferred providers, and benefits. One key difference is that dental insurance has a yearly maximum reimbursement limit, while medical insurance starts covering costs after an individual reaches their out-of-pocket maximum.

Dental insurance is similar to medical insurance, but with a key difference: the insurance provider covers up to a set amount within a benefit period, usually a year. The patient is responsible for any costs that exceed this limit. The maximum allowable amount varies depending on your insurance plan and is important to know when considering costly treatments. Dental PPO plans categorize services into preventive, basic, and major, each with its own coverage percentage. For example, many PPO plans cover 100% of preventive services, 80% of basic services, and 50% of major services. However, these percentages are specific to each plan, so it's important to understand your coverage by reviewing your personal benefits. Any expenses not covered by insurance are the patient's responsibility.

Dental insurance typically covers a range of dental procedures, such as exams, cleanings (usually twice a year), basic treatments like fillings and crowns, as well as oral surgery and orthodontics. These services are usually categorized as preventive, basic, and major, with each category covered at a set percentage, leaving the patient responsible for the rest. Common coverage breakdowns include percentages like 100%/80%/50%. Orthodontic coverage is different, with age restrictions, limitations on beneficiaries, and specific coverage limits. Unlike other dental services, orthodontic coverage often has a lifetime maximum instead of an annual limit.

A PPO, or preferred provider organization, allows you to choose your own dentist without requiring a primary dentist. You can see specialists without needing a referral, and staying within the network can save you money. This is different from HMO/DHMO plans, which focus on low-cost dental services with little to no copayments through a designated primary care dentist or facility. With HMO/DHMO plans, you must choose a primary dentist and are typically limited to that choice unless referred to a specialist.

Typically, PPO plans provide coverage for two exams and cleanings within a calendar year.

Yes, in most cases. However, it is important to understand any exceptions and regulations before seeking treatment. For instance, your insurance may not cover a dental implant if there is a "missing tooth clause" and you were already missing the tooth. We can help you find out the specific rules that apply to your coverage.

Yes, in most cases orthodontic treatment is covered. However, there are specific regulations regarding age eligibility, covered beneficiaries, and maximum benefit amounts. Orthodontic coverage usually has a lifetime maximum rather than an annual limit. We can help you find out the specific rules that apply to your coverage.