Dental Insurance, Made Simple
Dental insurance can feel like its own language — the cards, the codes, the in-network and out-of-network rules, the surprise bills nobody warned you about. At Avery Family Dentistry, we don't think you should have to be an insurance expert to take care of your teeth.
Our front desk team works with insurance every single day, and we're happy to do the heavy lifting. Whether you have a PPO, an HMO, a Medicare Advantage plan, a Wisconsin-based plan, or a union benefit, please call us before you assume your coverage won't work here. In most cases, it works better than people expect.
Out-of-Network Doesn't Mean No Coverage
This is one of the biggest misunderstandings we run into, so let's clear it up first.
When a dental office is out-of-network with your plan, it does not mean your insurance won't pay anything toward your care. With most PPO plans, your insurance still reimburses a portion of your treatment, often a significant portion, based on what your plan calls an "allowable amount" or "usual and customary fee."
- In-network: The office has a contract with your insurance to charge specific pre-negotiated rates.
- Out-of-network: The office doesn't have that contract, but your insurance still pays a percentage of covered services. Your out-of-pocket cost may be slightly higher, but you keep your benefits.
We Verify Your Benefits Before You Sit in the Chair
- Contact your carrier on your behalf
- Review your annual maximum, deductible, and remaining benefits
- Outline what's typically covered for the treatment you need
- Walk you through your expected out-of-pocket cost before treatment begins
For Patients With Wisconsin-Based or Union Insurance
A lot of the families we care for live in Illinois but work in Wisconsin and that often means their dental benefits are tied to a Wisconsin-based employer, a union, or a regional labor fund. If that's you, here's the most important thing to know.
Crossing a state line for work doesn't have to mean crossing a state line for dental care. Many Wisconsin-based PPO plans, trade union plans, and labor benefit funds reimburse for treatment at our office, even though we're located in Illinois. Patients we see in this situation often include:
- Illinois residents working union jobs in Wisconsin (trades, manufacturing, transportation, and more)
- Patients whose insurance is tied to a Wisconsin-based employer
- Families with benefits through a Wisconsin-administered labor or pension fund
PPO vs. HMO: What's the Difference?
PPO (Preferred Provider Organization)
PPO plans give you the most flexibility. You can see any licensed dentist you want, and your insurance will pay toward your care whether the office is in-network or out-of-network. In-network usually means a lower out-of-pocket cost. Out-of-network does not always mean there is coverage.
With a PPO, you can come to Avery Family Dentistry and use your benefits, even if we're not on your in-network list.
HMO (Health Maintenance Organization)
HMO plans typically require you to choose a primary dentist from a specific in-network list. Treatment is generally only covered if it's done by that assigned provider. HMOs often have lower premiums but less flexibility in where you go.
Many people see "HMO" on their medical insurance card and assume their dental plan is also an HMO. That isn't always true. Medical and dental coverage are usually separate plans, with separate networks and separate rules. You might have an HMO on your medical side and a PPO on your dental side, meaning you have full flexibility when it comes to choosing a dentist.
If you're not sure which type of dental plan you have, don't write us off. Call us first. We'll look at your specific benefits and tell you exactly what you have, what's covered, and what your options are.
Insurance Plans We Work With
PPO & Commercial Insurance
Medicare Plans
