Dental insurance made easy at Tend

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 specialist, either, but you will save money if you see one in your plan’s network.

These differ from DHMO insurance plans that typically cover dental services at a low cost and 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 otherwise referred to a specialist.

The main difference between PPO and HMO (or DHMO for dental) insurance plans is flexibility. PPO plans let you visit almost any dentist without a referral, while HMO/DHMO plans require you to choose a dentist within a set network and typically have more structured care coordination. PPOs offer more choice, while HMOs/DHMOs usually have lower costs and predictable copays.

At Tend, we work with many PPO plans and can help you understand your benefits before your visit, so you can make confident, informed decisions about your care.

We do our best to accept the widest range of dental PPO insurance plans, but there are a few exceptions. Currently, Tend does not accept:

• Medicaid or most Medicaid-based dental plans
• Medicare Advantage dental plans
• Some HMOs, DMOs, or Healthplex-type plans that strictly limit provider networks or coverage options

If your plan isn’t accepted, don’t worry. We’ll let you know before performing any treatment so you can make an informed choice about proceeding. Our team can also help you explore dental financing or out-of-network insurance options.

Dental insurance works similarly to your medical insurance, with the main difference that the 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 it 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 for 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.

Dental insurance usually helps cover preventive and restorative care, but every plan is different. Most policies include routine exams, cleanings, and X-rays at little to no cost, while fillings, crowns, and other treatments may be partially covered. Cosmetic services such as whitening and veneers are typically not included.

Orthodontics are unique and typically have rules around age, who is covered, and how much is offered (i.e., there is a lifetime max versus an annual amount).

Unfortunately, dental insurance doesn’t always cover the full cost of treatment. Most plans include annual maximums, co-pays, and deductibles, which means you may still be responsible for part of the bill. Preventive services, such as exams and cleanings, are often covered at a higher rate, while restorative or cosmetic dentistry may have limited coverage.

At Tend, we provide upfront estimates before any treatment begins, so you’ll always know what’s covered and what’s not. Our team will help you maximize your benefits and explore flexible payment options if needed.

Claims are more likely to be denied if:

• The service isn’t covered under your plan
• Annual maximums or frequency limits have been reached
• Required waiting periods haven’t been met
• The claim is missing information or documentation
• The treatment is considered cosmetic or not medically necessary

Coverage rules vary by plan, so even common procedures may be denied depending on your benefits.

Your insurance carrier determines claim approvals, but reviewing your plan details ahead of time can help avoid surprises.

For in-network care, we’ll provide an estimate based on your benefits. For out-of-network care, your carrier can help confirm coverage before treatment.

If your dental insurance claim is denied, don’t worry, our team will help you understand why. Common reasons include missing documentation, plan limitations, or services not covered under your policy. We’ll review the details with you, clarify next steps, and help you resubmit or appeal when possible.

To help avoid surprises, we provide an estimate of your coverage and out-of-pocket costs before treatment begins. That way, you’ll know what to expect from your insurance in advance.

The basics of dental insurance are similar to other types of employer-provided coverage, such as medical or vision insurance. Most plans are offered through your employer, include a monthly premium, and have specific provider networks and defined benefit levels that outline what’s covered.

The key difference is how costs are capped. Dental insurance has an annual maximum, a set amount your plan will pay toward your care each year. Once that limit is reached, you’re responsible for any additional costs. Medical insurance works the opposite way: it begins covering more after you reach your out-of-pocket maximum.

HSA (Health Savings Account)

An HSA lets you set aside pre-tax dollars to help pay for eligible health and dental care, including dental exams, cleanings, and more.

If you have a high-deductible health plan, an HSA can be a flexible way to cover dental costs now or later. Unused funds roll over from year to year.

FSA (Flexible Spending Account)

An FSA allows you to use pre-tax dollars for dental care and other eligible healthcare expenses. FSAs are typically offered through your employer and can be used for routine dental visits or planned treatment.

Funds usually need to be used within the plan year, though some plans offer a grace period or limited rollover.

Most plans only cover a percentage of treatment costs and have limits like deductibles, annual maximums, or coinsurance that affect how much they pay.

For example:

• You might not have met your deductible yet.
• Your plan could have reached its annual maximum.
• Certain procedures may only be partially covered.

At Tend, we believe there should never be surprise costs or hidden fees. Before any treatment begins, our team provides a clear estimate showing what your insurance will cover and what you may be responsible for.

You can always check with your insurance company to find out what they are and how much they cover. However, the Tend insurance team can check for you and give you an exact break down. 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 preventive by Tend and your insurance! Provide us with your info, and we’ll tell you exactly what is covered and how much you’ll owe.

Being out of network simply means Tend does not have a direct contract with your insurance provider. It does not mean we don’t take your insurance. We take all insurances except DHMOs, Medicaid, Healthplex, and Emblem. For those carriers with which we have a direct contract, 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.

If you don’t have dental insurance, you still have plenty of options at Tend Dental. We believe everyone deserves access to high-quality care, so we make it easy to get the treatment you need.

You’ll always receive transparent, upfront pricing before treatment begins. We also offer flexible payment plans and financing options to help you spread out costs over time. Preventive visits, like exams and cleanings, can help you avoid bigger dental issues (and expenses) later on.

Our team can also recommend personalized treatment plans that fit your goals and budget.

Most dental insurance plans cover two cleanings and exams per year, typically spaced about six months apart. These preventive visits are often covered at 100%, meaning there’s usually no out-of-pocket cost to you. Some plans may include additional benefits, like fluoride treatments or X-rays, but coverage details vary by provider.

At Tend, we’ll help you understand your plan and schedule your visits so you can make the most of your benefits. Regular cleanings and exams are the best way to keep your mouth healthy and avoid more costly treatments later on.

The cost of a dental cleaning and exam without insurance at Tend is $375.

Most dental insurance plans don’t cover teeth whitening since it’s considered a cosmetic treatment, not a necessary procedure. Of course, coverage varies by plan, so it’s best to check with your provider or ask your Tend care team to review your benefits. We’ll explain your options and provide clear pricing before treatment begins.

Most dental insurance plans don’t cover veneers, since they’re considered a cosmetic treatment rather than a medically necessary procedure. Insurance usually focuses on preventive and restorative care, such as exams, cleanings, and fillings, rather than treatments designed to enhance your smile’s appearance.

That said, coverage can vary by plan. In rare cases, veneers may be partially covered if they’re needed to restore damaged teeth after injury or decay. Our team can review your plan, explain your benefits, and provide a clear cost estimate before treatment begins.

In most cases, yes. However, there are exceptions and rules that are important to know prior to your visit. For instance, an implant would not be covered if you were previously missing your tooth and your coverage includes a “missing tooth clause”. At Tend, we can help you determine which rules are in place for your specific coverage.