prosthetic dentistry - wagnild & mueller 450 Sutter Street, Suite 1636
San Francisco, CA 94108
Phone: (415) 956-5162
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Insurance FAQs

 

What does my plan cover?

Most plans cover:

  • Preventative treatment (exams and cleanings)
  • A portion of restorative treatment (fillings)
  • A portion of larger restorative treatment (crowns, bridges)
  • Some implant crowns (depending on the plan)
  • Some emergency treatment (for pain, infection, or broken teeth)
  • There are limitations, though
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What is NOT covered?

Most plans limit payment:

  • Insurance usually covers dental hygiene only every 6 months, even if you need more frequent cleanings.
  • Diagnostic casts, which we need for more complex cases, are generally not covered.
  • Crowns and bridges are usually covered for decayed or fractured teeth, but usually not for teeth damaged from wear.
  • Veneers are considered cosmetic, and are usually not covered.
  • Replacement crowns or bridges, after 5 years, but only if there is new decay or other clinical problem. Some policies only cover replacements after 7-10 years.
  • Many policies cover implant crowns, but not the implant surgery.
  • Temporary partial dentures (stayplates) used during implant healing are usually not covered.
  • Nightguards are covered by some policies but not others.

There are a variety of dental insurance plans with a multitude of coverage options. Our staff is familiar with the administrative procedures, but are not experts about your actual coverage details. Please direct any plan coverage questions to your company Employee Benefits department. These are the pros, so that you will get the best information. back to top »

 

Can I find out what my insurance will cover, in advance?

  • We can submit a Predetermination of Benefits. (If you need this to make a decision)
  • Insurance companies take several weeks to respond. (We cannot schedule appointments until then)
  • For urgent care, waiting can be a problem for you.
  • IMPORTANT: Even a written approval from your insurance carrier is NOT a guarantee of insurance payment. (Deductibles, payments to other offices, employment changes, impact the actual insurance payment)
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Why doesn't my plan cover what I thought it would?

Your employer purchased a plan based on what they wanted to offer to attract and retain employees and, of course, the cost. Benefits are dictated by this contract, not by your dental needs. Dental insurance may or may not cover a portion of your treatment. Even if you think your insurance company should pay more, it may not. back to top »

 

What if my insurance doesn't cover the treatment?

We are dedicated to providing the dental care that is required, regardless of what your insurance covers. We have direct payment options for these instances. back to top »

 

IMPORTANT! Even a written approval from your insurance carrier is NOT a guarantee of insurance payment. Deductibles, insurance payments to other dental offices or for other dental services, employment changes and other issues can impact the actual insurance payment.

Prosthetic Dentistry  |  Galen Wagnild, D.D.S. & Kathy Mueller, D.M.D.  |  450 Sutter Street, Suite 1636  |  San Francisco, CA 94108  |  (415) 956-5162
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