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What you need to know about insurance

One of the most confusing aspects of dental treatment is dental insurance. Your dental insurance is a contract between the insurance company and your employer. Your employer chooses the level of dental insurance available to you. If your employer is large enough, they may have several options to choose from. Since dental insurance, relative to medical insurance, is relatively inexpensive, if you are offered a more comprehensive plan that isn’t much more expensive, that will usually be your best and most cost effective option in the long run.

The biggest misconception about dental insurance is that it exists to help you take care of your teeth. Insurance companies exist to make money, and they are very skilled in that regard. If you don’t go to the dentist and don’t use your available dental benefits, it’s money the insurance company doesn’t have to pay out. They also have a financial incentive to not cover certain treatment. Never allow the dental insurance companies to make a decision about your dental treatment. Your dental health is very important, and decisions about it should be made between you and your dentist.


There are three basic types of dental insurance:

  • UFee-for-Service–A Fee-for-Service plan has no network. It allows you to go to any dentist you choose. It is the least restrictive coverage option, but most likely has the highest premiums.
  • HMO–A Health Maintenance Organization (HMO) is the most restrictive coverage you can have. If you stay in network, you have coverage. If you choose to see a dentist outside of the HMO network, you have no coverage and will be responsible for all fees.
  • PPO–A Preferred Provider Organization (PPO) is a combination of an HMO and a Fee-for-Service plan. This option gives you the most flexibility. Usually for preventive and diagnostic services, you have full coverage in or out of network. For restorative treatment, you will have higher coverage when you stay in the network and less coverage when you go out of network, but not significantly less. For example, there is a MetLife program that allows 80% coverage in network and 60% coverage out of network.



Here are the insurances Robert L. DeFazio DMD participates with:

  • United Concordia: We participate with all of their Fee-for-Service plans and their PPO plans. We do not participate with any of their HMO plans.
  • UPMC Dental Advantage: We participate with all of their Fee-for-Service plans as well as their PPO plans. We do not participate in UPMC for You, UPMC for Life, or any of their HMO plans.
  • Delta Dental: We participate with all of their Fee-for-Service plans and their PPO plans. We do not participate in their HMO plans.
  • We do not participate in Gateway or any of the Medicare or Medicaid plans.



We work very hard to maximize our patients’ dental insurance benefits. We will resubmit and appeal claims we feel should be covered. Our office manager, Diane Coleman, has over 40 years of experience in the dental field, including eight years working for Aetna. Her extensive knowledge of insurance coverage is a great benefit to our patients. You will never be surprised by a bill. We will determine your coverage and tell you what will be covered by your insurance and what your financial responsibility will be. We have several methods of payment. We accept, cash, check, Visa, MasterCard, and American Express. We also participate with CareCredit. CareCredit is a very flexible third-party financing group that usually has lower rates than a typical credit card as well as comfortable monthly payments.

http://www.carecredit.com