Think Your Dental Insurance Has You Covered? Let's Talk About What It Really Means
We know that dental insurance is confusing. If you have ever thought, “I have insurance, so I'm covered, right?” you are not alone.
At Prostho Endo Dental Group in North Bethesda and Vienna, we strongly believe that you deserve to know exactly what you are paying for before treatment begins.
Our billing team is here to decode the insurance maze with you and we also offer our in-house dental membership plan. No jargon, no surprises, just straight talk about your coverage and costs.
At Prostho Endo Dental Group in North Bethesda and Vienna, we strongly believe that you deserve to know exactly what you are paying for before treatment begins.
Our billing team is here to decode the insurance maze with you and we also offer our in-house dental membership plan. No jargon, no surprises, just straight talk about your coverage and costs.
Key Takeaways
- Did You Know Your Dental Benefits Disappear on December 31st?
- Think Out-of-Network Means Breaking the Bank?
- What If You Could Use Your Insurance Twice in Two Months?
- Are You Throwing Away a 20-30% Discount on Dental Work?
- Why Won't Insurance Cover the Treatment That Could Transform Your Smile?
How We Help You Understand Dental Insurance Basics
Unlike medical insurance that covers big emergencies, dental insurance is more like a maintenance plan. Cleanings and checkups get 100% coverage but specialty work like crowns or root canals is where it gets super tricky.
Most dental insurance works in three tiers. Preventive care gets 100% coverage. Basic procedures like fillings are covered at 70-80%. Major procedures like crowns and bridges, and root canals are typically covered at 50%. Since we specialize in prosthodontics and endodontics at Prostho Endo, most of our work falls into that major category.
Here's the kicker: dental insurance caps out at $1,000-$2,000 per year. That's barely enough for one or two crowns. Your premium is what you pay monthly to keep insurance active. Your deductible is typically $50-$100 that you pay before insurance kicks in. Your annual maximum is the absolute cap on what insurance pays each year. Once you hit it, you are on your own until next year.
Most dental insurance works in three tiers. Preventive care gets 100% coverage. Basic procedures like fillings are covered at 70-80%. Major procedures like crowns and bridges, and root canals are typically covered at 50%. Since we specialize in prosthodontics and endodontics at Prostho Endo, most of our work falls into that major category.
Here's the kicker: dental insurance caps out at $1,000-$2,000 per year. That's barely enough for one or two crowns. Your premium is what you pay monthly to keep insurance active. Your deductible is typically $50-$100 that you pay before insurance kicks in. Your annual maximum is the absolute cap on what insurance pays each year. Once you hit it, you are on your own until next year.
How We Help You Avoid Common Insurance Surprises
Waiting Periods
Just signed up for new dental insurance? Most plans make you wait 6-12 months before covering major procedures. But at Prostho Endo, we don't make you wait. We offer flexible payment plans and our in-house membership program that skips the waiting game entirely.
Annual Maximums
That $1,000-$2,000 cap disappears every December 31st. Use it or you lose it. If you need multiple crowns, we will help you strategize. Maybe one in December and one in January, using two separate years' benefits. This simple timing trick could save you $750 or more.
Limitations and Downgrades
Insurance companies love fine print. They might only cover a crown every 5 years, or only pay for silver fillings instead of tooth-colored ones. These limitations can add $100-$300 to your bill per procedure. We will tell you upfront when insurance is playing games with coverage.
Just signed up for new dental insurance? Most plans make you wait 6-12 months before covering major procedures. But at Prostho Endo, we don't make you wait. We offer flexible payment plans and our in-house membership program that skips the waiting game entirely.
Annual Maximums
That $1,000-$2,000 cap disappears every December 31st. Use it or you lose it. If you need multiple crowns, we will help you strategize. Maybe one in December and one in January, using two separate years' benefits. This simple timing trick could save you $750 or more.
Limitations and Downgrades
Insurance companies love fine print. They might only cover a crown every 5 years, or only pay for silver fillings instead of tooth-colored ones. These limitations can add $100-$300 to your bill per procedure. We will tell you upfront when insurance is playing games with coverage.
How We Make Out-of-Network Coverage Work for You
Yes, Prostho Endo is out-of-network with most plans. But here's what that actually means: we provide specialist-level care without insurance company restrictions. If you have a PPO plan, you still get benefits here. The difference is often just 10-20%.
Here's a real example: A $1,300 crown might cost you $650 in-network versus $820 at Prostho Endo. That's $170 more for specialty care from experienced prosthodontists and endodontists. For many patients, that difference is worth it for the expertise and personalized attention they receive.
Here's a real example: A $1,300 crown might cost you $650 in-network versus $820 at Prostho Endo. That's $170 more for specialty care from experienced prosthodontists and endodontists. For many patients, that difference is worth it for the expertise and personalized attention they receive.
We file claims for you or give you everything you need for reimbursement. Our billing team calculates your actual cost before treatment. No surprises!
If you have an HMO or DMO plan, those only work in-network, which means zero coverage at Prostho Endo. But we offer payment plans, financing through CareCredit, and our membership program as alternatives.
If you have an HMO or DMO plan, those only work in-network, which means zero coverage at Prostho Endo. But we offer payment plans, financing through CareCredit, and our membership program as alternatives.
It was really, really great. I was very satisfied and didn’t expect it to be done so quickly. I didn’t feel any pain at all. I can honestly say I was very happy with it.
Zahra M.
What's Covered and What's Not
Preventive care like cleanings, exams and X-rays is usually covered at 100%. Basic procedures like fillings get 70-80% coverage. Major procedures which is our specialty at Prostho Endo are typically covered at 50% which means you will pay roughly half out-of-pocket.
Here's where insurance shows its limits: dental implants are rarely covered. Cosmetic work like veneers and teeth whitening gets excluded. Full-mouth rehabilitation and adult orthodontics usually aren't covered either. These procedures can be life-changing. They are just not on insurance's radar. That's where our alternative payment options come in.
Some procedures need pre-authorization. This is insurance's way of saying “prove you really need this.” We strongly recommend it for major work. If your claim gets denied, we will help you appeal with detailed documentation. Our team has extensive experience fighting for your coverage.
Here's where insurance shows its limits: dental implants are rarely covered. Cosmetic work like veneers and teeth whitening gets excluded. Full-mouth rehabilitation and adult orthodontics usually aren't covered either. These procedures can be life-changing. They are just not on insurance's radar. That's where our alternative payment options come in.
Some procedures need pre-authorization. This is insurance's way of saying “prove you really need this.” We strongly recommend it for major work. If your claim gets denied, we will help you appeal with detailed documentation. Our team has extensive experience fighting for your coverage.
How We Help You Get More From Your Benefits
Strategic Timing
Your benefits reset on January 1st. Unused benefits disappear forever. We encourage patients to schedule exams in the fall so we can complete some work before year-end, then tackle additional treatment in January with fresh benefits.
Dual Coverage
Have insurance through your job and your spouse's? We will coordinate both to minimize your out-of-pocket costs. Your secondary insurance picks up what your primary doesn't cover. Our billing team handles all the paperwork.
FSA/HSA
These pre-tax accounts are like getting a 20-30% discount on dental work. FSAs are use-it-or-lose-it by year-end, so they are perfect for planned dental work. HSAs roll over year after year. We provide all the documentation you need for reimbursement.
Your benefits reset on January 1st. Unused benefits disappear forever. We encourage patients to schedule exams in the fall so we can complete some work before year-end, then tackle additional treatment in January with fresh benefits.
Dual Coverage
Have insurance through your job and your spouse's? We will coordinate both to minimize your out-of-pocket costs. Your secondary insurance picks up what your primary doesn't cover. Our billing team handles all the paperwork.
FSA/HSA
These pre-tax accounts are like getting a 20-30% discount on dental work. FSAs are use-it-or-lose-it by year-end, so they are perfect for planned dental work. HSAs roll over year after year. We provide all the documentation you need for reimbursement.
Alternatives When Insurance Falls Short
Our In-House Membership Plan
For one annual fee, you get complimentary preventive care plus significant discounts on all procedures. No waiting periods, no deductibles, no annual maximums. If you need extensive work, the savings often beat traditional insurance once you factor in premium costs.
Flexible Financing
CareCredit and LendingClub offer 0% interest for 6-24 months if you meet payment terms. We also offer in-house payment plans where you pay a portion upfront and divide the rest over several months. If you need care, we will find a way to make it work financially.
For one annual fee, you get complimentary preventive care plus significant discounts on all procedures. No waiting periods, no deductibles, no annual maximums. If you need extensive work, the savings often beat traditional insurance once you factor in premium costs.
Flexible Financing
CareCredit and LendingClub offer 0% interest for 6-24 months if you meet payment terms. We also offer in-house payment plans where you pay a portion upfront and divide the rest over several months. If you need care, we will find a way to make it work financially.
How Our Billing Team Has Your Back
Our billing team calls your insurance company before your appointment to verify your benefits. We get the real numbers. Your annual maximum, deductible status, coverage percentages and any limitations. You will receive a written estimate before treatment begins. No surprises. Ever.
After treatment, we prepare and submit detailed claims to your insurance company with all necessary documentation. We monitor your claim status throughout the 30-45 day processing period and handle any issues that come up.
After treatment, we prepare and submit detailed claims to your insurance company with all necessary documentation. We monitor your claim status throughout the 30-45 day processing period and handle any issues that come up.
Every estimate includes the total procedure cost, what insurance will cover and your expected out-of-pocket amount. We itemize everything clearly. If there's uncertainty, we recommend pre-authorization. The estimate includes everything: doctor's fee, materials, lab costs and follow-up visits. No hidden fees.
Your Pre-Appointment Checklist
Coming prepared makes everything easier. Grab your insurance card (or just snap a photo on your phone), your ID, and your FSA or HSA card if you've got one.
Before you come in, give your insurance company a quick call. Ask them the important stuff: How much of my annual maximum have I used? Did I hit my deductible yet? What's covered for major work like crowns or root canals? And do I actually have out-of-network benefits?
And when you are here? Ask us anything. Want to know what you will actually pay? Wondering if splitting treatment saves you money? Curious if our membership plan beats your insurance?
Let us figure it out together. No pressure and just straight answers!
Before you come in, give your insurance company a quick call. Ask them the important stuff: How much of my annual maximum have I used? Did I hit my deductible yet? What's covered for major work like crowns or root canals? And do I actually have out-of-network benefits?
And when you are here? Ask us anything. Want to know what you will actually pay? Wondering if splitting treatment saves you money? Curious if our membership plan beats your insurance?
Let us figure it out together. No pressure and just straight answers!
Dr. Shin, Bryanna and Jay at the Vienna location are fantastic! Dr. Shin is very caring, professional and knowledgeable. He makes sure that we understand the process. The entire team are very friendly and always greets us with a smile
Charmaine V.
FAQ: Your Top 3 Questions Answered
Does Prostho Endo Dental Group accept my insurance?
Our team at Prostho Endo Dental Group works well with all PPO insurance plans, even though we are out-of-network with most. You will still receive substantial benefits often just 10-20% less than in-network. We verify your coverage, file claims and maximize your benefits. If you have HMO/DMO insurance, we offer payment plans and our membership program as alternatives.
Ready to find out exactly what your plan covers? Call us today and schedule your consultation online We will verify your benefits before you even come in.
What if I don't have dental insurance?
If you don't have dental insurance, our in-house membership plan provides preventive care plus discounts on everything else. No waiting periods, deductibles or maximums. We also offer CareCredit financing (often 0% interest) and flexible in-house payment plans. We will find a solution that fits your budget.
Don't let lack of insurance hold you back. Schedule a consultation and let's talk about which option makes the most sense for you.
How do I know what I'll actually pay?
The way you will know what will you actually pay is by working with our billing team because they help verify your insurance benefits before treatment and provide a detailed written estimate. You will know exactly what insurance covers and what you are responsible for before treatment begins. For complex cases, we will submit pre-authorization to confirm coverage. Complete transparency, every time!
Want to know your real costs upfront? Book your appointment today. We will give you a complete breakdown before you make any of your decisions.
Conclusion: Clear Care, Clear Costs
At Prostho Endo Dental Group in North Bethesda and Vienna, we believe exceptional care and straightforward financial communication go hand in hand. Our billing team verifies coverage, files claims, handles appeals and provides crystal-clear estimates. When insurance isn't enough, we offer a dental membership plan and flexible financing.
Look, insurance is confusing. We know. But don't let that stop you from taking care of your teeth. Ready to move forward? Let's have a real conversation. We will break everything down, answer whatever questions you've got and honestly? We will find a way to make it work with your budget.
Schedule your consultation and you will see what we mean. No runaround and no hidden costs. Just a team that actually wants to help.
Look, insurance is confusing. We know. But don't let that stop you from taking care of your teeth. Ready to move forward? Let's have a real conversation. We will break everything down, answer whatever questions you've got and honestly? We will find a way to make it work with your budget.
Schedule your consultation and you will see what we mean. No runaround and no hidden costs. Just a team that actually wants to help.
