Understanding Our Insurance Policy

Important Update: Out-of-Network with United Healthcare

As of December 5th, 2024, Renew Family Dentistry is out-of-network (OON) with United Healthcare dental insurance. We still accept your insurance and will continue to submit claims on your behalf, just as we always have.

If your dental plan includes out-of-network benefits (and most do), your insurance will still contribute toward the cost of your visits. If your current plan does not include OON benefits, your insurance company will only contribute toward treatment costs with an in-network provider.

Frequently Asked Questions

What does “out-of-network” mean?

Why did you choose to go out-of-network?

What if my insurance doesn’t have any out-of-network benefits?

Do you offer financing options?

What questions should I ask my insurance about OON coverage?

Can I see an example of how much I will have to pay out of pocket?

Why should I stay with Renew Family Dentistry when I could find an in-network provider?

What are your fees?

Are there other payment options?

Q: What does “out-of-network” mean?

Out-of-network dental benefits refer to care provided by a dentist who doesn’t have a contracted agreement with your dental insurance plan. Insurance plans typically have a network of dentists who have agreed to provide services at pre-negotiated rates (in-network).

We are a non-restricted provider with your plan. This means you can still use your insurance benefits at our office, even though we don’t accept the lower fee schedule that in-network providers must follow. As a non-restricted provider, we’re also not limited to offering only the treatment options your insurance plan might dictate.

Even though we’re out-of-network with United Healthcare, we still gladly accept your insurance and will submit claims on your behalf. Your insurance will typically cover a portion of your treatment cost based on your plan’s out-of-network benefits. There might be some additional out-of-pocket expenses compared to seeing an in-network provider, since we don’t have a negotiated rate with United Healthcare.

Our priority is ensuring you receive the best care possible, with treatment recommendations based on what you actually need—not what your insurance company is willing to cover.

Q: Why did you choose to go out-of-network?

Our decision to go out-of-network was based on our commitment to three core priorities.

Our Patients

You are the heart of everything we do. Providing top-quality care requires time, expertise, and resources—all of which come with costs. If we based our level of care solely on insurance reimbursements, we wouldn’t be able to provide the experience you deserve. We’d be forced to:

• Schedule more appointments in less time
• Reduce the time we spend with each patient
• Compromise on the quality of your care

We don’t want to shorten your time with our providers just to see more patients. We’re committed to offering exceptional care in a comfortable, caring environment—something that doesn’t always align with insurance companies’ profit-focused operations.

Our Team

Our doctors couldn’t provide excellent care without our incredible team of hygienists, assistants, and administrators. With rising living costs and inflation, it’s important that we pay our team fairly. Unfortunately, insurance companies haven’t increased reimbursements in decades, despite rising costs everywhere else. We want to offer our staff competitive pay, benefits, and a healthy work-life balance.

Our Practice

Since founding Renew Family Dentistry in 2020, our mission has remained unchanged: “Renew Family Dentistry is committed to serving the North Dallas community in a welcoming, comfortable, and compassionate environment. Our professional team utilizes the latest technology to create personalized treatments while ensuring that every patient receives the attention and care they deserve for healthy, long-lasting smiles.”

These qualities matter to us—not to dental insurance companies. We refuse to change our practices or care to fit their profit-driven model. To stay true to our values, we needed to step away from the inequitable relationship of being an in-network office.

Q: What if my insurance doesn’t have any out-of-network benefits?

If your insurance has limited or no out-of-network benefits, you have several options:

1. Contact your insurance carrier or employer about adding or improving OON benefits. Many patients have told us they switched dentists because their previous office “stopped accepting their insurance.” Having OON benefits gives you more flexibility in selecting a dental office with minimal cost impact. *While improving coverage on medical plans can significantly increase monthly costs, the difference for dental plans is typically much smaller.
2. Consider our in-office KLEER Membership. With no deductible or maximum discount, the membership more than pays for itself as long as you visit us for at least two annual checkups.
3. Consider a Health Savings Account (HSA) or a dedicated medical savings account instead of traditional dental insurance. This puts you in control of your funds without the limitations of insurance plans.

Dental insurance typically costs around $60 per month ($720 annually) with maximum annual benefits of $1,000-$2,000. After paying for the plan, the most you can receive back is $280-$1,300. In years when you only need routine care, you may pay far more for the plan than you use.

Unlike medical insurance, dental plans aren’t regulated the same way and can exclude essential services.

How much will treatment cost me now?

With numerous insurance plans available, providing a one-size-fits-all answer is impossible (another way insurance companies create confusion). The following table shows examples of in-network vs. out-of-network benefits:

Many plans provide the same coverage whether you’re in-network or out-of-network, while others offer slightly reduced coverage for out-of-network offices.

We’ll always provide treatment plans that include:

• Our fees for treatment (your responsibility if insurance declines coverage)
• Estimated insurance coverage based on your plan

We can also submit a predetermination before treatment to check for exclusions or downgrades, though this can take 3-4 weeks and isn’t a guarantee of payment. The only thing we can guarantee is our fees. We’re here to help with any questions!

Q: Do you offer financing options?

Yes! We understand financial constraints can prevent patients from accepting recommended dental treatment. We offer:

• Cherry Financing and CareCredit for longer-term payment plans, with options often including 0% APR and payment plans up to 72 months. There’s no hard credit check, and it only takes about 2 minutes to see your options.

If you have any questions about our third-party financing options, contact us.

Q: What questions should I ask my insurance about OON coverage?

As an out-of-network provider, we can only confirm if your insurance plan is active, but we don’t have full access to all insurance benefit information. We highly recommend asking your insurance company these important questions:

• Do I have out-of-network benefits? What are they?
• What are my annual maximum and deductible? What services does my deductible apply to?
• What are the coverage percentages for preventive, basic, major, implant, and orthodontic services?
• How frequently will my plan cover cleanings, exams, and X-rays?
• When does my plan year reset?
• Is there a waiting period?
• Is there a “missing tooth clause”?
• Are there material downgrades on crowns or fillings?
• Is assignment of benefit to the provider accepted for out-of-network providers?
• What is the maximum allowable charge for common procedures with out-of-network providers?

Detailed Explanations of Insurance Questions

What are my out-of-network benefits?

Ask if there are out-of-network (OON) benefits. If there are NO out-of-network benefits, you’d need to see an in-network provider for insurance to contribute toward treatment costs. MOST dental plans include at least some out-of-network benefits, and many offer OON benefits comparable to in-network benefits. Having OON benefits allows you the freedom to choose your provider based on your own preference.

What is my annual maximum benefit? What is my annual deductible?

The standard annual maximum is around $1,500. This means your insurance won’t pay more than $1,500 toward your dental claims in any given plan year. The most common deductible is $50-$100 and typically doesn’t apply to preventive services. If your plan’s deductible does apply to preventive services, you would need to pay that deductible at your first visit of the plan year, even if it’s just a cleaning.

What is my “Plan Year”?

Most plans run on a calendar year, meaning the annual maximum and deductible reset every January. However, the plan year can vary. It’s important to know when your plan’s benefits reset each year.

Coverage percentages for different service types:

Standard coverage is typically:

• 100% for preventive services
• 80% for basic services
• 50% for major services

If there is implant and/or orthodontic coverage, those are usually 50% as well.

“Preventive/diagnostic” services typically include cleanings, exams, and most X-rays. Fillings are typically considered “basic” services. Dental crowns and bridges are often considered “major” services.

How frequently will my plan cover cleanings, exams, and X-rays?

Ask about frequency limitations for:

• D1110 – Prophylaxis (standard dental cleaning)
• D0120 – Periodic exam (there are several types of exams, and typically, they all share frequency)
• D0274 – 4 Bitewing Images (X-rays we take annually)
• D0210 – Full Mouth Series X-rays (recommended every 3-5 years)

Is “assignment of benefit” to the provider accepted for out-of-network providers?

The insurance company will likely say either “as long as there is a signature on file” or “no.” As long as assignment of benefit is accepted, payment can be sent directly to our dental office. If it’s not accepted, insurance payment will only go to you (the patient), so we will need to collect payment in full upfront, and you will be reimbursed by your insurance.

Is there a “waiting period”?

If there is a waiting period, ask how long it is and what types of services it applies to. During a waiting period, your insurance won’t contribute toward that type of service until the waiting period has been met (and until you’ve paid for the plan for that long). Most frequently, waiting periods last 6-12 months and do not apply to preventive services like cleanings and exams.

Is there a “missing tooth clause”?

If there is a “missing tooth clause,” your insurance won’t pay for restoring a tooth that was extracted prior to the start of your plan’s coverage. For example, if you had a tooth extracted before your insurance coverage began, the new plan won’t contribute toward the cost of a bridge or implant to replace that extracted tooth.

Are there any material downgrades?

Some insurance plans still include clauses that allow them to only pay toward the cost of amalgam (silver) fillings or metal crowns on posterior teeth (those that typically don’t show in your smile). These plans consider composite (white) fillings and porcelain crowns an “elective upgrade,” despite these being the standard of care for all teeth for decades. In these cases, the insurance will pay the covered percentage of the lower fee, and you are responsible for the difference.

What is the maximum allowable charge for specific procedures with out-of-network providers?

Just because a plan says it covers 100% does not mean it covers 100% of our fee. When patients see an in-network provider, that provider has agreed to a set “fee schedule.” Maximum Allowable Charges (MAC) or Usual & Customary Rates (UCR) are the terms for the dollar amounts that insurance companies use to process claims for out-of-network providers. Most UCR rates are well above our office fees, so 100% coverage actually means 100% coverage. Occasionally, the MAC/UCR is lower than our office fee, which would mean insurance will pay 100% of that lower fee, leaving you responsible for anything above it.

Q: Can I see an example of how much I will have to pay out of pocket?

Sure! Here’s what you can expect when paying out of pocket when you see out-of-network providers:

Ask for the specific fees below. If the insurance company won’t give you that, ask if the fees are within or above their Maximum Allowable Charge (MAC) and/or Usual, Customary, and Reasonable (UCR).

To understand your potential out-of-pocket costs, ask about these specific fees:

Please note: Your annual maximum typically applies to ALL services, including dental cleanings. Once you reach your maximum benefit, your insurance won’t pay for any other services until your plan year resets. Most plans also have an annual deductible that applies to certain services.

Q: Why should I stay with Renew Family Dentistry when I could find an in-network provider?

Our fees are based on regional averages that account for local cost of living, making them comparable to other offices’ out-of-network fees. Running a dental office involves significant overhead, and we:

• Use quality materials and current technologies
• Employ an incredible team of clinicians and administrators
• Spend more time with our patients, not less

Increasingly, in-network providers must choose between cutting expenses or seeing more patients in less time. That’s why many privately owned practices are transitioning to out-of-network status.

Q: What are your fees?

We believe in transparency when it comes to costs. Like Southwest Airlines’ “Transfarency” approach, we strive to be straightforward about our fees during this transition to out-of-network status.

Some states have passed legislation like Senate Bill 1731, requiring healthcare providers to disclose charges for common services.

We’re happy to be transparent about our fees, with the understanding that treatments are tailored to each patient’s specific needs. Many clinical situations require multiple services for the best outcome—for example, some crowns need a core build-up procedure while others don’t.

What’s the difference between medical and dental insurance?

The main difference lies in who the out-of-pocket maximum applies to:

Medical Insurance:

• The out-of-pocket maximum applies to the patient
• Once you’ve paid a certain amount, your insurance covers the rest
• Example: For a $20,000 medical bill, you might pay $5,000, and insurance covers the remaining $15,000

Dental Insurance:

• The out-of-pocket maximum applies to the insurance company
• The insurance only pays up to their maximum (typically $1,500-$2,000)
• Example: For a $15,000 dental bill, insurance might only pay $1,500, leaving you responsible for $13,500

Other differences:

• Medical pre-authorizations typically stand behind their coverage determinations.
• Dental pre-determinations always include “This is not a guarantee of payment.”
• Dental insurance often takes weeks to respond, potentially discouraging patients from pursuing recommended treatment.

Q: Are there other payment options?

Yes! Our dental office offers the Kleer Membership Plan:

• $420 annual program (365 days from signup)
• Includes 2 cleanings, 2 exams, and a set of X-rays
• 15% discount on any treatment needed during the year
• Exclusions: wisdom teeth extractions and orthodontics

Unlike dental insurance with its restrictions and exclusions (usually found in “high-end” dental insurance plans), our membership plan is straightforward and often more cost-effective. Here’s an example of the “highest-end” plan from the Delta Dental Premium Plan Policy:

• D1110 – Prophylaxis (dental cleaning) – $127
• D0120 – Periodic Exam – $72
• D0210 – Full Series X-ray – $180
• D0274 – Four Bitewing X-rays – $89