Talking to the dentist about your dental plan

Know how to answer any question that may come up during your dental visit.

1. “What dental plan will you be using?”

Say the name of the specific plan — Careington Care 500 or Dental Access Plan powered by the Aetna Dental Access Network.

2. “What type of plan is that?”

Say it is a dental discount plan or a dental savings plan — not insurance (so not a PPO or HMO).

If you are using the Dental Access plan, you can mention that it is the discount plan that uses Aetna’s PPO fee schedule. They should already have the fee schedule in their office. If they do not, they need to contact Aetna’s provider relations department.

If you are using Careington, the dental office should already have a Careington price list in the office. If they do not, please have them call us at 855-329-6305 so we can take care of this for them.

3. “We accept all PPOs”

There is a big difference between “accept” and “in-network.”

Language like “accept” or “file with” can sometimes mean the dental office isn’t in-network with any dental plans; however, they are willing to file with a PPO to see if they can get some reimbursement. Anything that is not reimbursed, however, is passed on to you.

Translation: This does not necessarily mean you will save money at their office if you purchase a PPO. Any out-of-network benefits you may receive are rarely worth what you would be paying for the plan.

4. “How will you be paying?”

Our plans will make your overall dental bill much more affordable, and then you will pay the remainder directly to the dental office (not us).

You will usually be able to pay the remainder with either cash or card. If you have a Health Savings Account, you can use that to pay for the rest. If you need to set up some sort of payment plan, ask the dentist about your financing options before getting any dental work done. Some dental offices are more flexible about payment plans and financing than others.

5. “We don’t accept that plan”

What do you do if you’ve found the dental office on our list, but they say they do not accept the plan when you call? Here are some steps to help:

  1. Make sure you were looking at the correct plan (for example, they may participate in the Aetna Dental Access Network, not the Careington network).
  2. Find out if they used to accept the plan but recently notified Careington of cancellation (sometimes recent cancellations haven’t populated on our list yet).
  3. Call us right away at 855-329-6305 if the above two options don’t help. We can help sort out if it’s a mistake on our end, if the dental office hadn’t notified us of discontinuing participation yet, or if the office assistant is mistaken.

6. “That plan doesn’t cover much / doesn’t reimburse us”

If the dental office assistant confirms that they are in-network, but they try to discourage you from using the plan, they may be misunderstanding how the plan works for you.

We do not reimburse the dental office. However, that doesn’t mean the plan isn’t beneficial to you (and to them in the long run)!

Because insurance companies reimburse the dentist for a certain percentage, they also need to add a lot of fine print to make the business model work for them. They may often adjust rates, make people wait to save on certain procedures, exclude people with certain conditions from even purchasing insurance, and limit coverage to around $1,000-$1,500 a year.

Dental savings plans are different. They work more like a Costco membership. Tens of thousands of dentists across the country agree to lower rates for our members. In return, they spend less money on advertising and marketing because people find them on our website. Also, they don’t have to spend hours on the phone or filing paperwork to get reimbursement from insurance companies. Accepting a discounted price upfront often works better financially for them, both in the short and long term. So we think it’s a win-win for both dentists and patients.

One of the most common ways members come to us is through their dental office telling them about these plans and recommending they join. If you are speaking with a dental office that is in-network but seems reluctant to use the plan, or if you are running into any other difficulties with a dental office, please call us at 855-329-6305 so we can help.

7. “That procedure is 20% off”

If you are using the Careington 500 plan and the procedure is 20% off, there are three things that may be happening:

  1. The procedure you need is not listed on the Careington discounted fee schedule

    2. The fee schedule includes roughly 95% of the most common dental procedures, but some common unlisted procedures include all-porcelain/ceramic crowns or bridges, some types of implants, nonstandard dentures, and fluoride treatment.

  2. The procedure you need is being performed by an in-network specialist

    3. Pediatric dentists are classified as specialists

  3. The dentist’s original price is even lower than our discounted price

    4. This scenario is very rare, but Careington does have a catch-all savings of 20% if your dentist’s usual fee on a procedure happens to be lower than the discounted price on the list.

Please let us know if your savings are less than you hoped, and we will be glad to explore other options that may help you save more.

8. “That procedure is not discounted”

The Careington 500 plan and Dental Access plan both save on all official dental procedures at participating dentists.

If you are being told by an in-network dentist that a procedure is “not discounted,” there are a few things that may be going on:

  1. An out-of-network specialist came to their office to perform some of your procedures.
  2. They had to send something to a lab (for example, certain types of crowns, bridges, and dentures) and passed on the lab fee to you (these fees are usually $100-$200). Sometimes you can avoid lab fees by finding a dentist with in-house equipment.
  3. The procedure does not have a designated American Dental Association code. For example, Invisalign is still considered a product rather than a procedure by many dentists, so it may not be discounted the same as traditional braces would.