The PPO Plans on Our Accepted List
The PPO plans on our accepted list cover most major dental carriers, including Delta Dental and Aetna. We hold contracts with some plans and accept others without one. Our team files the claim for every accepted plan. The table below groups each plan by how we work with it. Call (626) 219-7180 to confirm your exact plan, because carriers offer many plan versions.
| How we work with the plan | Plans |
|---|---|
| Contracted PPO plans | Delta Dental, MetLife, Guardian, Aetna, Cigna, Anthem Blue Cross, Blue Shield, United Healthcare, GEHA/Connection, Ameritas, Dental Benefit Providers (DBP), DenteMax, Humana, First Dental Health, Dental Health Alliance |
| Accepted without a contract | United Concordia, Principal Financial Group |
| Not on our list | HMO plans, DHMO plans, Medicaid |
Select a carrier name to open its own plan details page.
Plans We Contract With
A contracted plan means our office agrees to the insurer's negotiated fees. These plans treat us as in-network, so staying in-network often leads to savings on covered care. Our team rechecks your benefits every plan year because carriers change their terms. Understanding the contract status helps you plan.
Plans We Accept Without a Contract
We accept United Concordia and Principal Financial Group without a contract. Our team still files your claim with the insurer. Your balance may differ from an in-network plan, so call for an estimate first.
Plans We Do Not Accept: HMO, DHMO and Medicaid
Our accepted list covers preferred provider organization plans only. We do not list HMO (health maintenance organization) or DHMO plans. We do not currently accept Medicaid. Call us if your plan is not listed, and our team will tell you what works. Patients on approved credit can still use our financing options.
From Benefits Check to Final Balance: How Claims Work Here
Claims work here in four steps, from your benefits check to your final balance. Each patient gives us insurance details when scheduling. Our team then handles the paperwork for you. We estimate your coverage before treatment and file your claim afterward. Understanding each step makes your visit easier.
Check Your Benefits
We check your insurance plan details before you start receiving treatment, so your benefits are confirmed early. Have these items ready when you call:
- Your insurance card, front and back
- The policyholder's name and birth date
- Your plan year start and end dates
- The names of any other dental plans you hold
Plan Your Treatment
Our benefits coordinator reviews your coverage with you before treatment starts. You receive a coverage estimate for your planned treatments. The coordinator helps you maximize your benefits and keep your remaining balance low.
File Your Claim
We submit your claim directly to your insurance provider after treatment ends. Most insurers process claims within 15 to 60 days. Contact your insurer if payment arrives later than that.
Settle Your Balance
We explain your pricing and costs upfront and offer solutions for any remaining balance. Our goal is making each balance clear before paying. The financing section below covers those options in detail.
How PPO Coverage Levels Work for Cleanings, Fillings and Crowns
PPO coverage levels work in three tiers for cleanings, fillings and crowns. PPO plans are designed to pay a share of each bill based on the type of care. Preventative care earns the highest share, basic care a middle share, and major care the lowest. The table shows typical national averages. Your own plan may pay more or less.
| Type of care | Examples | Typical plan share |
|---|---|---|
| Preventive care | Dental exams, teeth cleanings and oral hygiene visits | About 100 percent |
| Basic care | Dental fillings | About 80 percent |
| Major care | Crowns, dental bridges and other dental restorations | About 50 percent |
According to the ADA Health Policy Institute, 58.2 percent of privately insured people saw a dentist last year. Only 28.4 percent of uninsured people did.[1] These ranges are estimated averages for national dental insurance plans. Please call our dental office for an insurance coverage check on your own plan.
Annual Maximums, Deductibles and Waiting Periods
An annual maximum caps what your plan pays in one plan year. Most plans carry a maximum between $1,000 and $2,000. A deductible is the amount you pay before coverage begins. A copayment is a fixed fee some plans charge per visit. Some plans add a waiting period before they cover major care. Unused benefits usually reset when the plan year ends. Read our guide to using your dental benefits before the year ends.
Ask your insurance company these questions before treatment:
- What are my plan year dates?
- How much of my annual maximum remains?
- Which waiting periods apply to major care?
- What percentage do you cover for preventive, basic and major procedures?
Why Your Final Balance Can Differ From the Estimate
Your final balance can differ from the estimate for several reasons. Insurance pays a percentage of treatment costs, not the full amount. An estimate reflects what we know on the day we prepare it. Your insurer makes the final claim decision, and that decision can change the result.
These are the most common causes of a different balance:
- Lower coverage than the plan summary suggested
- Procedures your plan does not cover, such as cosmetic care
- A deductible you have not yet met
- An annual maximum you have already used
- A plan downgrade during the year
As noted by CMS, patients pay 38.3 percent of United States dental spending out of pocket.[2] Health care overall runs only 10.5 percent. We never move a procedure date to improve your coverage, because that constitutes insurance fraud. Our billing stays honest, and our estimates stay estimates, never guarantees.
Financing and Payment Options When Insurance Does Not Apply
Financing and payment options apply when insurance does not cover your care. Patients without insurance, with an unlisted plan, or with a balance after insurance can finance treatment. Our treatment coordinator helps you find the best financing choice for your needs. Financing gives you access to care that your plan does not cover. We accept cash, debit cards, credit cards, Mastercard and mobile payments. Our options make dental treatments easy to plan. Call (626) 219-7180 with questions.
| Your situation | Your next step |
|---|---|
| No dental insurance | Apply for financing with our treatment coordinator |
| Plan not on our list | Call so our team can confirm what works |
| Balance after insurance | Choose a financing plan or pay by card |
| Medicaid | Call to discuss payment and financing options |
Financing Partners and Approved-Credit Plans
We work with these financing partners:
- CareCredit
- Cherry
- LendingClub
- Sunbit
- Premier Financing
Approved credit can qualify for low monthly payments and 0 percent interest plans lasting 6, 12 or 18 months. Checking your options does not affect your credit score. Read the details on our financing options page.
If Your Plan Is Not on Our List
Call (626) 219-7180, and our team will confirm what works for your plan. Financing remains your fallback when a plan does not apply. Patients with Medicaid follow the same steps.
Dr. Solomon Heifets and the Team Who Answer Your Insurance Questions
Dr. Solomon Heifets and our team answer your insurance questions. Dr. Solomon Heifets, DDS, leads our Pasadena, California practice, and Dr. Arkady Tsibel, DDS, also treats patients here. Both dentists provide general dentistry and other dental services at our Pasadena office. We file claims for treatment provided here. Our benefits coordinator checks plan details before your visit. Our treatment coordinator explains financing. Our staff speaks English and Spanish.
Dental Insurance Questions We Hear Most
Do you accept my insurance?
Yes, we accept most major PPO dental plans. Call (626) 219-7180 to confirm your exact plan.
How do I check whether you take my specific plan?
Find the plan name on your card and compare it with our list. Then call (626) 219-7180 with your member ID, and our team will confirm.
What is the difference between plans you contract with and plans you accept?
With a contracted plan, we agree to the carrier's negotiated fees. With an accepted plan, we still file your claim, but your balance may differ.
Do you accept HMO or DHMO plans?
Our accepted list covers PPO plans, and we do not list HMO or DHMO plans. Call us to confirm before you book.
Do you accept Medicaid?
We do not currently accept Medicaid. Please call our office to discuss alternative payment and financing options.
What if my plan is not accepted?
We may not be in-network with every plan. We offer flexible financing options regardless of your coverage.
How long do insurance claims take to process?
Most insurance companies process claims within 15 to 60 days, and we file them on your behalf. Contact your insurer if payment runs later.
What should I bring to my first visit?
Bring your insurance card and a photo ID. Let us know about any dental work done elsewhere this year, so we can track your benefits accurately.
What should I do if my insurance changes?
Contact us right away to update your insurance information. We then keep your benefit estimates and claim processing accurate.
Confirm Your Benefits or Request an Appointment
You can confirm your benefits or request an appointment with our team. We check your plan before your visit when you call. You can also request an appointment online. Our Pasadena CA office welcomes patients Monday through Friday. We also confirm your plan year dates and remaining benefits before you arrive.
| Office detail | Information |
|---|---|
| Phone | (626) 219-7180 |
| Address | 181 N Hill Avenue, Pasadena, CA 91106 |
| Hours | Monday to Friday, 9 AM to 6 PM |
Pasadena Dental Office and Orthodontics gives PPO patients a clear path from benefits check to finished treatment. Our team confirms your plan, files your claim, and explains your balance before work begins. Patients whose plans do not apply can finance care on approved credit. Dr. Heifets and Dr. Tsibel treat patients at 181 N Hill Avenue on weekdays. Call (626) 219-7180 today or request an appointment online. We will answer your questions, confirm your coverage, and schedule a visit that fits your benefits.