Allentown Dental Insurance

At Tomko Dental Associates of Allentown, we want to help our patients get the dentistry services they need within their budgets. That starts with offering affordable preventive, restorative, and cosmetic dentistry services. Additionally, we are happy to process and file dental insurance claims to help you maximize your treatment coverage. We offer in-network dental care for a number of insurance plans to ensure you have the lowest possible out of pocket costs. If you have questions or want to find out more about your dental insurance coverage, please don’t hesitate to call our team. We’ll do our utmost to answer your questions over the phone or schedule an appointment for you to visit our Allentown dental office.

Dental Benefit Basics

There are two main types of dental insurance coverage. Health maintenance organization (HMO) plans have lower monthly premiums, but they place greater restrictions on the dental offices you can visit in order to receive coverage. Preferred provide organization (PPO) plans are designed to offer patients a greater amount of flexibility, but they do have a higher monthly premium. Every dental benefit plan represents a unique agreement between the patient and insurer, so we’ll need to review your policy before providing accurate estimates of your out of pocket costs. In most cases, you’ll receive some combination of the following coverage:

• 80 to 100% coverage for the cost of preventive dentistry
• 50 to 80% coverage for the cost of restorative dentistry
• 20 to 70% coverage for the cost of orthodontics (when elected)

Tips for Maximizing Your Coverage

In order to make the most of your dental benefit plan, you should keep the following tips in mind:

• Talk to the team before scheduling your first visit to make they will process and file your claims and ensure any treatments you need are covered
• Know your annual maximums, usually between $1000 and $1500, and make sure you don’t exceed them in any plan year
• Ask for preauthorization for advanced treatment options, and don’t assume the coverage is available
• Visit the dentist regularly for checkups and teeth cleanings to ensure you avoid the need for more advanced dentistry services that receive lower percentages of treatment coverage
• Visit an in-network dental office to ensure your out of pocket treatment costs is minimized

In-Network VS Out of Network Dentistry

While HMO dental insurance policies place strict parameters on which dental offices you can visit, PPO plans are designed to be more flexible. While you’ll receive coverage through any dental office, an in-network dentist will minimize your out of pocket treatment costs and help you avoid extra fees. Out of network dentists may charge treatment prices that are higher than those outlined by your insurer, but you’ll be responsible for paying the difference in pricing as well as the out pocket percentage of your treatment costs. In most cases, the differences in price are minimal, but an in-network dentist will help you avoid additional fees. Our team offers in-network coverage for a number of insurance plans, including:

• Guardian