Financial Policy

Dental West NYC Insurance Information

Understanding dental insurance shouldn’t feel complicated.

Navigating Dental Insurance Made Simple

Many patients feel confused about dental insurance coverage and whether they can visit a practice that’s out of network. At Dental West NYC, we believe in transparent communication about insurance so you can make informed decisions about your care. Our billing coordinator, Valerie, works closely with every patient to maximize their insurance benefits and ensure they understand exactly what to expect.

Insurance Information

We Accept All Major PPO Insurance Plans for Out-of-Network Reimbursement

Dental West NYC is a fee-for-service practice, which means we are considered out of network with all major insurances. However, this doesn’t mean your insurance won’t help with costs. Here’s what that means for you:

• We accept all major PPO insurance plans
• Payment is due at the time of service
• We submit all claims to your insurance company on your behalf
• You receive reimbursement directly from your insurance provider
• Our billing coordinator Valerie works to maximize your benefits

If you have PPO dental insurance, we file claims for you and help ensure you receive the maximum reimbursement your plan allows.

Understanding Fee-For-Service Dentistry

How Our Approach Benefits You

Many patients initially worry about being out of network, but fee-for-service dentistry often provides greater value in the long run. When you visit an insurance-based practice, they may maximize procedures that insurance will cover, taking yearly x-rays whether you need them or not, recommending treatments that might be premature, and potentially overlooking preventive approaches that could save your natural teeth.

At Dental West NYC, we make treatment decisions based on what you actually need, not what insurance will cover. We tailor treatment plans to your specific needs rather than insurance quotas. For healthy patients, we take x-rays only when clinically necessary—typically every two to three years—instead of annually. This preventive focus helps you avoid more expensive treatments later.

Our billing coordinator is expert at knowing what will and will not be reimbursed and how to code procedures appropriately to maximize your insurance benefits. For example, if a smaller procedure code would save you money but still allow for proper reimbursement, we’ll make that adjustment. We spend time on the phone with insurance companies to ensure you’re getting the full value of your coverage.

Frequently Asked Questions

Many patients have similar concerns when learning about our fee-for-service model. Here are answers to the most common questions we receive.

How does being out of network actually benefit me?

Being out of network allows us to practice dentistry based on your health needs rather than insurance company requirements. Insurance-based practices can maximize procedures that insurance will cover to benefit their bottom line, such as taking x-rays annually even when not clinically necessary. At Dental West, we focus on prevention and only recommend treatments you truly need. While you pay upfront, we submit all claims and work diligently to maximize your reimbursement. Many patients find they receive 95% or more of the fee back from their insurance company while receiving more personalized, conservative care.

Will my insurance cover anything if you’re out of network?

Yes! If you have PPO insurance, your plan typically includes out-of-network benefits. While the percentage of coverage may differ from in-network rates, most patients still receive substantial reimbursement. We review your specific plan and provide detailed estimates of what you can expect back from your insurance company. We submit all claims on your behalf, and you receive reimbursement directly from your insurer. The key difference is that you pay us directly and then get reimbursed, rather than the insurance company paying the provider.

What if insurance says they won’t cover something you’ve recommended?

We base our treatment recommendations on clinical necessity, not insurance coverage. If insurance decides not to cover a procedure, that’s their decision, but it doesn’t change what you need for optimal oral health. However, we’re highly skilled at working with insurance companies and coding procedures appropriately to maximize what your plan will cover. We’ll explore every option to help you receive the highest possible reimbursement while ensuring we’re providing the care you actually need.