Insurance

At Quartz Dentistry we are happy to work with Delta Dental Premier. We are unrestricted with all other insurance companies. We will verify benefits and bill your insurance company as a courtesy. Please understand that the contract is between you and your insurance company and is ultimately the patient’s responsibility.

We are NOT a Medicaid, Dentaquest, or Health First Colorado approved Provider. Unfortunately, we are unable to see you if this is your insurance carrier. We are as frustrated as you are and have tried our best to accommodate this plan. However, we are being limited by Colorado Medicaid and told that we cannot see you as a patient, even as a cash - pay patient. If we become aware of your Medicaid coverage, we will be obligated to dismiss you as a patient.

Dental Insurance Basics

The best way to take full advantage of your dental insurance coverage is to read your plan information carefully and understand its features. Do not rely upon estimates given at the dental office – your financial responsibility may often exceed their best guess, which is based upon broad

general guidelines provided by your plan. Contact your HR or your insurance company with specific coverage or benefit questions before each visit. This is your responsibility as an insurance product consumer, and has nothing to do with your health or the medical necessity of treatment.

Plan Basics

Most insurance companies offer benefit plans with different features. Your employer chooses the coverage level available to you. At Quartz Dentisty, we are contracted with Delta Dental Plans, however, as a courtesy we will always submit all claims to your insurance company. Any uncovered benefits will be the responsibility of the patient. Dental benefits are calculated within a benefit period, which is typically one year – but not always a calendar year. Be aware of your benefits and when you are approaching deductible payments or plan maximums. We will do our best to have a close estimate at what we believe your insurance company will cover.

We also offer cash pay incentives as well as senior discounts and teacher annual credits for teachers who do not have insurance or who utilize an insurance carrier are out-of-network. 

Maximums

Most dental plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period (usually January through December). The patient is personally responsible for paying costs above the annual maximum. Consult your plan booklet for specific information about your plan.

Deductibles

Most dental plans have a specific dollar deductible. It works like your car insurance. During a benefit period, you personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Your plan information will describe how your deductible works. Plans do vary on this point. For instance, some dental plans will apply the deductible to diagnostic or preventive treatments, and others will not.

Coinsurance

Many insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. What you pay is called the coinsurance, and it is part of your out-of-pocket cost. It is paid even after a deductible is reached.

Pre-Treatment Estimate

If your dental care will be extensive, you may ask your dentist to complete and submit a request for a cost estimate, sometimes called a pre-treatment estimate, a preauthorization or prior authorization. This will allow you to know in advance what procedures are covered, the estimated amount the benefit plan may pay for treatment, and your financial responsibility. A pre-treatment estimate is not a guarantee of payment. When the services are complete, and a claim is received for payment, insurers may consider eligibility, maximum, any deductible requirements, as well as any limitations, exclusions, etc.

Limitations and Exclusions

Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits. These limitations and exclusions are carefully detailed in the plan booklet and warrant your attention. This booklet can help you develop realistic expectations of how your dental plan can work for you.

Allowances for some procedures covered under your benefits may be subject to limitation or denial based upon clinical criteria applied by the insurance company’s licensed dentist or consultant staff. Insurance companies generally maintain written guidelines for the use of clinical criteria in making benefit determinations. You may obtain a copy of such guidelines from the insurance company by sending a request in writing for the specific benefit category or dental procedure range.The materials provided to you by the insurance company are guidelines used to authorize, modify or deny coverage for persons with similar illnesses or conditions.Specific care and treatment may vary depending on individual need and the benefits