1205 SE Professional Mall Blvd., Suite #202
Pullman, WA 99163
Phone: 509-332-8084          Fax: 509-332-6380

INSURANCE


As a dentist and provider for numerous plans, I know insurance can be confusing! We can help you understand your benefits and get the maximum possible from your insurance, Health Savings Account, or Flex Spending Account. When we get the Patient Registration Form information from you, we verify your plan benefits and can provide you with the information you want about your plan.


When you need treatment, we can provide you with a detailed plan, which includes an estimate of how much your insurance company may pay for each procedure, as well as the portion you will be expected to pay at the time of service. Please keep in mind that your insurance company is free to change the rules and allowed benefits at any time, so we are unable to guarantee insurance processing policies we do not control. 

We are a preferred provider for several dental insurance companies, including: Aetna, Assurant, United Concordia; and all of the Delta Dental Plan groups (including Washington Dental Service and their Uniform Plan), and we continue to evaluate and join new insurance groups. And of course, we are happy to provide care and submit insurance to any insurance plan that you have!

One insurance question we get asked frequently is - HOW DO DENTAL INSURANCE PROCESSING POLICIES AFFECT COVERAGE AND OUT-OF-POCKET COSTS FOR REGULAR PROFESSIONAL CLEANINGS?

   Most dental insurance plans recognize the financial benefit of preventive care and cover a regular dental cleaning (i.e. a prophylaxis) at 100%. Some plans will even penalize patients by decreasing their benefit for other services if they do not get their teeth cleaned regularly. When submitting your cleaning appointment charges to your dental insurance, however, things get complicated. The problem is that not all patients require the same care in order to clean their teeth, and, there are several different procedure codes used by insurance companies to identify which type of cleaning you had. If you require only a small amount of under-the-gum cleaning and mostly need removal of light plaque and stain, your procedure will be billed to insurance as a ‘prophylaxis’, which is considered “preventive care” and is usually paid at 100%. On the other hand, if you have a heavy buildup of calculus (bacterial deposits which have hardened onto the teeth), your procedure will cost more, not only because of the increased time involved to clean your teeth, but also because the procedure must be billed to insurance using the “periodontal therapy” codes like “scaling and root planning” which most insurance plans cover at a lower percentage, often requiring that you meet your out-of-pocket deductible before they cover anything. These insurance company policies essentially create two very different reimbursement rates for two relatively similar procedures (i.e. teeth cleanings). Now for some good news…with proper documentation and preauthorization, many dental insurance plans will allow periodontal therapy maintenance visits at the “preventive care” or 100% rates and may even qualify periodontal patients for more frequent professional cleanings, provided patients don’t postpone their cleaning appointment so long that their dental cleaning needs exceed the maintenance level.

Confused yet? As you can see, your out-of-pocket expense for your regular professional teeth cleaning appointments can vary considerably depending on how your insurance plan processes the different procedure codes as well as how well you take care of your teeth. As confusing as all of this information is, the take home message is clear: If you want what’s best for your teeth and what’s best for your pocketbook, BRUSH, FLOSS, and SCHEDULE YOUR CLEANING APPOINTMENTS.