Insurance

You can contact your insurance company directly to find out your out-of-network benefits and coverage.

Alternatively, our expert insurance team at Dr johnson’s office can handle this for you.

Just provide us with your insurance carrier name and subscriber ID, and we’ll give you a detailed breakdown of your coverage, saving you time and hassle.

Many out-of-network plans cover preventive services like exams and cleanings at 100%.

At Dr Johnson’s office we consider these services preventive, so your exam may be fully covered.

Share your insurance details with us, and we’ll confirm exactly what’s covered and if there’s any out-of-pocket cost for you.

Being out-of-network means we don’t have a direct contract with your insurance provider, but it doesn’t mean we don’t accept your insurance.

We work with most insurances except DHMOs, Medicaid, Healthplex, and Emblem. When in-network, your insurance company has negotiated rates with us.

For out-of-network services, we use standard pricing and apply your coverage percentage to determine any out-of-pocket costs.

While dental and medical insurance share some similarities, like being employer-provided and having monthly premiums, they differ in key ways.

Dental insurance typically has an annual maximum limit on coverage, meaning the insurance provider will only reimburse up to a certain amount each year.

In contrast, medical insurance usually covers expenses after you reach your out-of-pocket maximum for the year. Dental insurance also has specific guidelines on who you can see and the types of benefits provided.

Dental insurance functions similarly to medical insurance, with one key distinction: your insurance provider covers a “Maximum Allowable” amount within a benefit period (typically a year), and you’re responsible for any costs exceeding that limit.

The maximum amount varies by plan, so it’s essential to know yours when planning for more expensive treatments.

Most dental PPO plans divide services into categories—Preventive, Basic, and Major—with varying coverage levels.

For example, preventive care is often covered at 100%, basic services at 80%, and major treatments at 50%. You are responsible for anything not covered by your plan.

A PPO, or “Preferred Provider Organization,” offers flexibility in choosing your dentist.

You don’t need to select a primary dentist, but having one is recommended.

No referrals are necessary to see a specialist, though visiting providers within your plan’s network will save you money.

This differs from DHMO plans, which generally have lower costs and minimal copayments.

With a DHMO, you must choose a primary care dentist and are limited to that dentist, unless referred to a specialist.

In most cases, two exams and cleanings in a calendar year.

In many cases, dental implants are covered by insurance.

However, there are exceptions and specific rules to be aware of.

For example, implants may not be covered if your policy has a “Missing Tooth Clause” for teeth that were previously missing.

We can help you understand the specific rules of your coverage.

In most cases, yes.

Coverage for orthodontics often includes specific rules regarding age, plan eligibility, and the amount covered.

Typically, there’s a lifetime maximum rather than an annual limit for orthodontics.

We can provide details on the rules and coverage specific to your plan.