Lexi Me Her-Ellison DDS
What a difference a smile can make!
Call: (559) 582-2827

Dental Insurance and Financing

 

Dental treatment does not have to be out of reach!

Dental Insurance

Get the smile you always wanted by utilizing our many different payment options. For your convenience, we accept and bill all PPO insurances. Our office is an in-network provider for several PPO insurances including United Concordia, MetLife, Guardian, Delta Dental, Stanislaus Foundation, First Dental Health and their subsidiaries. We are proud to be in-network with Tricare and CCPOA and have been providing dental care to our military and peace officers for years. If you have any questions about which insurances we accept, please give us a call at 559-582-2827 or email us at herellisondds@gmail.com and we will be glad to help.

  

 

Financing Your Dental Treatment

We accept most payment options including check, money order, or credit card (Visa, Mastercard, and American Express). Our office can also help you utilize your Health Savings or Flex Savings accounts. For those patients who need the flexibility of monthly payments, we accept CareCredit as well as Lending Club Patient Solutions, the premier partners in healthcare financing. Get up to 24 months to pay with ZERO (0%) interest or keep your payments low with extended payment plans up to 7 years! Find out if you qualify in less than 10 minutes at LendingClub.com or CareCredit.com. We also offer an in-office financing option for patients who want monthly payments on an automated schedule through our partner, DentalBanc. Call us today at 559-582-2827 or email us at herellisondds@gmail.com to schedule your appointment and we can discuss all of your financing options!

 


FAQs

What is the difference between HMO and PPO insurance?

 A Preferred Provider Organization (PPO) plan allows the patient to see the dentist of their choice. The insurance benefits can be paid for services rendered at any licensed dental office. A Health Management Organization (HMO) plan assigns the patient to a specific dentist. The dentist agrees to accept a specified amount to provide dental care to the patient. However, a HMO plan will not pay for any services rendered by any other dentist besides the assigned dentist. Therefore, if the patient chooses to see another dentist for any reason, no insurance benefits will be paid. Dental offices can choose to accept PPO, HMO, both, or no plans at all. As a dentist in Hanford, our office accepts PPO insurances only. If you have any questions about your insurance, please call our office at 559-582-2827.

 

What is the difference between an "in-network" and an "out-of-network" provider?

Being an "in-network" provider for your insurance plan means that the dentist has a contract in place with your insurance company saying that they will only charge you a set fee for specific procedures determined by the insurance company, usually lower than the dentist's usual and customary fee. Patients will usually save money when using an "in-network" provider versus an "out-of-network" provider. Being "out-of-network" means that the dentist does not have a contract in place and he/she will charge you his/her usual and customary fee for each procedure. You can still utilize your insurance benefits. However, the insurance may cover less and the total fee for the same procedure may be more, then if you went to an "in-network" provider. For some insurances, the in-network fee is the same as the dentist's usual and customary fee.

  

I have insurance. Why doesn't insurance cover this?

Dental insurance plans are designed to help with PART of your dental expenses and may not always cover every dental need. Dental plans and their benefits are an agreement between your employer/ group and the dental plan company. Our dental office has no control over your plan benefits and coverage. The typical plan includes limitations and exclusions as well as copayments and deductibles that must be paid before your dental benefits will go into effect. This can relate to the type or number of procedures, the number of visits or age limits. These limitations, exclusions, and copayments are carefully detailed in the plan booklet and warrant your attention. Plan booklets can be obtained from your employer’s human resources or from the dental company that services your plan.

 

What does my insurance cover?

Every insurance plan has different benefits, coverage, limitations, and exclusions. Even plans within the same dental insurance company may have different benefits. Each patient who has an exam done in our office will get a treatment plan with a good faith estimate based on the patient's own insurance coverage at that time. We make an effort to make sure we create a comprehensive plan that will meet each patient's individual needs and to make the financial responsibilities as transparent and accurate as possible. However, we can not guarantee what an insurance company will pay. Insurance coverage can change or be dropped, benefits may be used at another dentist, or treatment may change, which can all affect the treatment plan cost.

 

Can I use my insurance and utilize a monthly payment option to cover my coinsurance and other out of pocket expenses?

 Yes. Our office will be happy to work out a financial plan that will best fit your needs.

 

Does your office give discounts?

Our doctors do volunteer on a regular basis with amazing programs such as CDA Cares, the Tulare-Kings Dental Foundation, The Samaritan Free Clinic in Visalia, and the Tzu Chi Mobile Clinic to provide free and discounted dental treatment to low-income patients. We do occasionally offer discounts that are available too all patients of the practice on such things like ZOOM! tooth whitening, orthodontics, biteguards, and Invisalign. Refer to our Current Promotions page for more information. The discount is applied to all patients who receive the service and insurance, if used, will be billed with the same discount noted.

The American Dental Association Code of Ethics prevents any dentist from waiving copayments and/or deductibles or providing discounts when utilizing dental insurance for ANY patient in the practice unless it is in a specific setting, like a federally-approved low-income clinic or is applied to all patients in the practice. Some dentists, in their own generosity, may offer discounts to some patients but in doing so, are unknowingly violating their professional code of ethics as well as rules surrounding insurance fraud. The ADA Code of Ethics states that:

1. "The fee for a patient without dental benefits shall be considered a dentist's full fee. This is the fee that should be represented on all benefit carriers regardless of any negotiated fee discount." Meaning, that if the dentist provides a discount to one patient, the new discounted fee now becomes his/her new usual and customary fee for all patients.

2. "It is unethical for a dentist to increase a fee to a patient solely because the patient is covered under a dental benefits plan." Meaning, if the dentist offers a "cash discount" to a person without dental insurance, they can not then charge a patient with insurance the full price. A dentist can not give a "$39 exam and x-rays" deal to a patient without insurance and then charge a patient with insurance the full fee.

3. "A dentist who accepts a third party payment under a copayment plan as payment in full without disclosing to the third party that the patient's payment portion will not be collected, is engaged in overbilling. The essence of this ethical impropriety is deception and misrepresentation." Meaning, insurance benefits do not go into effect until the patient has paid all of their share of deductible and copayment. If these fees are waived for the patient, the insurance company will not be responsible for paying their portion. If the dentist waives any of the copayment/deductible or gives a discount to the patient but still bills the insurance the full amount as if the fees were not waived, the dentist is overbilling which is insurance fraud.
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