Dental Insurance

Dr. Dounski  accepts all PPO  insurances, as well as unions and locals! 

As of December 2015, we are an in-network provider with:

• Aetna PPO
• Cigna PPO
• Delta PPO
• Metlife PPO
• Guardian PPO
• Assurant PPO
• Ameritas PPO
• Humana PPO
• Dentemax PPO
• Horizon PPO & Dental Option Plan

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For patients without insurance, there is a new fee schedule! From here on out, EVERY FEE is REDUCED! Our practice is committed to provide a full range of preventive and cosmetic options to help you achieve a cleaner, healthier and more attractive smile. We’ll work with you to determine the best course of treatment, the most convenient scheduling and most appropriate financial arrangements.

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Most dental insurance companies break down their benefit levels into three categories; Preventative, Basic and Major. It is very important to have an overall understanding of your own dental benefits before commencing with treatment.

  • Preventative services consist of prophylaxis (cleaning), dental evaluations (check ups) and x rays. The majority of insurance plans cover these services at 100%.
  • Basic services include fillings, root canals, periodontal procedures as well as oral surgery and are mostly covered at 70-80%.
  • Major services are crowns, bridges, dentures and implants all of which require more time for restoration or adjustment. These services are covered at 40-50%.

Our staff does their best to verify all of your insurance benefits to provide you with the most accurate and up to date information. If your insurance company or policy renews or changes, please notify us as soon as possible. Even the slightest policy change can have an effect on treatment plans/fees.

Because we don’t want anything to be a “surprise” financially, we present treatment plans before any treatment has started. We estimate your out-of-pocket portion based on the most up-to-date information we have, but it is ONLY AN ESTIMATE.

If you would like to know your exact insurance benefit, we will be happy to file a “pre-treatment authorization” with your insurance company prior to treatment. This does delay treatment by 2-4 weeks, but will give you the exact out of pocket figures you may require.

“What about my medical insurance?”

Most of the time, medical insurance policies only cover dental procedures that are needed due to an accident-related injury. No preventative care is through medical coverage.

Also, medical coverage allows you to pay a co-pay (for example, $25) as the only payment for doctor’s visits. Dental coverage is very different. The insurance company pays a certain percent and you, the patient, are required to pay the rest. This is why we show you a treatment plan ahead of time.

Some dental insurance plans have the following plan exclusions:

Missing tooth clause If a patient lost the tooth prior to getting coverage by their current insurance carrier, an implant, crown or bridge in that area will not be covered by the plan.

Downgrading Most insurances downgrade composite (tooth colored) fillings for amalgam (metal) fillings on molar (back) teeth. They consider composite fillings on molars to be cosmetic and therefore pay only for the metal fillings which are a lesser fee. This makes the patient responsible for a greater co-payment amount.