At Rise and Shine Pediatric Dentistry, we strive to provide the highest quality of dental care for Denver’s youngest smiles. This time of year, it may be open enrollment for many dental insurance plans. We are here to help our patients understand how to select a plan that can provide the best benefits to offset the cost of dental care at our practice.
Understanding what to look for in a dental insurance plan
When selecting a plan to use at Rise and Shine Pediatric Dentistry, it’s important to choose a PPO dental insurance plan. We are happy to submit claims for all PPO insurance policies on your behalf.
It’s important to look at deductibles, yearly plan maximums, co-payments, and age or frequency limitations for routine preventive care or more involved treatments such as restorations or extractions. These include procedures in our office as well as any other specialist offices in which you use your dental benefits, such as orthodontic or oral surgery practices. Your employer should be able to provide you with a description of covered benefits and frequency limitations, which don’t always align with the recommended best standard of care for even the most effective preventive measures or diagnostic tools, such as fluoride application or necessary radiographs. We can’t see if you’ve used your benefits in other offices, so it’s important to choose a plan that provides a level of coverage you’re comfortable with so you can anticipate your out of pocket costs if you plan to exceed the frequency limitations of the plan you choose.
Even if your employer has not changed, your dental benefits might have changed to a new carrier or new policy coverage under the same carrier. We are able to provide you with the best estimate for your insurance policy’s coverage if you submit your new policy to our office ahead of your visit, so please let us know when scheduling your child’s appointment if you have new insurance coverage.
How in-network vs. out-of-network coverage affects your costs
For 2026, we are in-network with Delta Dental as a Premier Provider and Dentaquest (Medicaid). We can know exact fee schedules for these carriers, but other carriers may reimburse at different fee schedules than our office’s since we are not contracted with them and are considered out of network. Benefit coverage is often described as a percentage of coverage, such as 80%-100% of “usual, customary, and reasonable” rates, though this varies significantly among dental plans and may not reflect the average fees in an area.
Network status determines the fees that insurance companies pay to a dental practice, but your costs may not change whether you see an in or out of network dentists. Your insurance company will encourage you to see an in-network provider because it reduces their costs, but most plans allow you to choose an in or out of network provider. It’s important to choose a plan with out-of-network benefits. You may be responsible for a portion of the cost of the visit with either in-network or out-of-network plans.
A dental insurance plan’s coverage is determined by how much your employer pays for the plan; the more an employer pays for coverage, the more benefits you typically receive. If your premium is high and coverage for preventive procedures is low, you may prefer to drop your dental insurance coverage and pursue care with our Elevate Smiles Advantage Program instead. Call us at 303-758-0223 to schedule your appointment with Dr. Villasenor today!
