Dr. Puri is in-network with most major California PPO dental insurance plans, including Delta Dental, Aetna, MetLife, Cigna, and UnitedHealthcare. The American Dental Association states that A PPO plan is regular indemnity insurance combined with a network of dentists under contract to the insurance company [1] (ADA, n.d.). Essentially, you are paying lower, pre-negotiated rates with in-network providers, allowing you to save significant money on cleanings, fillings, and more advanced restorative procedures.
Many California PPO plans have a $2,000 maximum that is reset on January 1st of each year. If you do not use these funds for your cleanings or necessary treatments, the money goes unused. Dr. Puri’s team specializes in "Year-End Benefit Optimization." We review your remaining balance in September and October to schedule your care before your benefits expire. This proactive approach ensures you receive the care you already paid for through your work premiums.
Many of our patients are covered by two PPO plans: classically, one plan through their employer and another through a spouse. This is known as Coordination of Benefits (COB). The American Dental Association endorses that Coordination of Benefits takes place when a patient is entitled to benefits from more than one dental plan [2] (ADA, 2025). It can be confusing which plan is the “primary” and which is the “secondary”. Clove Dental simplifies this by simultaneously filing with both insurers. Our goal is to partner with our patients in efforts to reduce your out-of-pocket costs as close to zero as possible.
Understanding the difference in your "Explanation of Benefits" (EOB) is vital for your long-term dental budget.
|
Feature |
In-Network (Dr. Puri) |
Out-of-Network |
|
Service Rates |
Pre-negotiated (Lower) |
Standard Office Fees (Higher) |
|
Preventive Care |
Usually 100% Covered |
Often requires a co-pay |
|
Balance Billing |
Prohibited (You save more) |
Patient pays the difference |
|
Paperwork |
Handled by Clove Dental |
Patient may need to file claims |
|
Durability of Care |
High-quality materials used |
Varies by provider |
A common concern amongst dental patients is receiving unexpected bills after an appointment. To mitigate this concern, Dr. Puri utilizes a formal Pre-Authorization process for major procedures like crowns, bridges, or deep cleanings. We send your digital X-rays and treatment plan to your PPO provider before we start. The insurance company sends back an "Explanation of Benefits" (EOB) detailing exactly what they will pay. This gives you a clear, written roadmap of your financial responsibility, allowing you to plan your budget with total confidence.
Standard PPO plans often categorize treatments into three tiers: Preventive, Basic, and Major. While cleanings are usually covered at 100%, major restorative work like high-quality crowns or periodontal (gum) therapy may be covered at 50% to 80%. Dr. Puri’s office is experienced in coding these procedures accurately to ensure your PPO recognizes the medical necessity of the treatment. We focus on using durable, high-end materials that meet your insurance's "Least Expensive Professionally Acceptable Alternative" (LEAT) clauses while still providing the premium care you deserve.
Dr. Puri’s in-network status is specifically designed to support the workforce in our California communities. Whether you are an "Up-and-Comer" at a local tech firm or a "Community Connector" in the public sector, we likely accept your specific group plan. We have deep experience with the PPO tiers offered by major California employers, including those in the healthcare, education, and technology sectors. Being in-network means you benefit from "contracted rates." These rates are often 30% lower than standard fees, providing immediate relief for your household budget from your very first visit.
The fastest way to confirm is to call our office with your member ID. Our coordinators are experts at navigating California employer-sponsored plans and can provide a breakdown of your specific coverage levels within minutes.
Most modern PPO plans in California have shifted toward covering composite (tooth-colored) fillings. However, some older plans may "downgrade" coverage to the cost of a silver filling. We always check this for you beforehand to avoid unexpected costs.
Yes. If you have a dental emergency in California, your PPO insurance typically covers the diagnostic exam and X-rays.