Insurance

You can always check with your insurance company to find out what they are and how much they cover. However, the Clove Camarillo insurance team can check for you and give you an exact breakdown. All we need is your carrier name and subscriber ID.

In many instances, out-of-network benefits cover preventative services at 100%. Your exams and cleanings are considered preventative by Clove and your insurance! Give your info and we’ll tell you exactly what is covered and how much you’ll owe.

Being out-of-network simply means Clove does not have a direct contract with your insurance provider. It does not mean we don’t take your insurance. For those carriers that we do have a direct contract with, they have negotiated prices. When out of network we use the base price for the service and apply the coverage percentages that correspond to your out-of-network benefits to calculate what you’ll owe.

The basic premise of dental insurance is the same as other types of employer-provided insurance such as Medical and Vision. Most dental insurance is provided by your employer, has monthly premiums associated with that coverage, has guidelines on whom you can see, and differences in benefits provided. The major difference with dental insurance is that the insurance provider has a yearly maximum they will reimburse, whereas a medical insurance provider covers reimbursement after the individual reaches their own out-of-pocket maximum.

Dental insurance works similarly to your medical insurance. The main difference is that the dental insurance provider is responsible for “First Money Out”, meaning they cover up to a “Maximum Allowable” amount in a given benefit period (usually a year) and the patient is responsible for any amount over that limit. The Maximum Allowable amount is unique to your insurance plan and is important to know what it is when seeking more expensive care. Further, as with Medical Co-Insurance, Dental PPO plans typically cover services based on ranges or categories: Preventive, Basic, and Major. As an example, most PPO coverages provide 100% coverage for Preventive services, 80% coverage on Basic, and 50% for Major. This breakout is plan-specific and you will need to consult your personal benefits to understand your coverage. What is not covered by your insurance is the patient’s responsibility.

A PPO is a “Preferred Provider Organization”. PPOs do not require you to choose a primary dentist, although one is recommended. You don’t need referrals to see specialists either, but you will save money if you see one in your plan’s network. These differ from DHMO insurance plans that typically coverdental services at a low cost. There are also minimal or no copayments with a pre-selected primary care dentist or a dentist facility with multiple dentists. You are required to select a primary dentist and are restricted to that dentist unless referred to a specialist.

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

$375

In most cases, yes. However, there are exceptions and rules that are important to know prior to care. For instance, an implant would not be covered if you were previously missing your tooth and your coverage includes a “Missing Tooth Clause”. At Clove, we can tell you what rules are in place for your specific coverage.

In most cases, yes. Orthodontics are unique and typically have rules around age, who on your plan is allowed to use, and how much is offered (i.e. there is a lifetime max versus an annual amount). At Clove, we can tell you what rules are in place for your specific coverage.