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.

An estimate is our best projection of what you may owe for your treatment based on your insurance details at the time of your visit. It is based on the information your provider shares with us, such as coverage percentages and remaining benefits.

It’s important to know that an estimate is not an exact representation of what your actual bill will be. Insurance companies make final coverage decisions after a claim is processed, and they may take into account factors we can’t see, like pending claims or changes to your remaining benefits. Because of this, your final cost may be different from your estimate.

For all of the reasons listed above, it's essential that you are familiar with your coverage and keep track of pending claims. This will give you a clearer picture of what you out of pocket costs will be after treatment.

We'll provide an estimate for what your insurance will cover based on the most current information available at the time. However, we can’t see pending claims or real-time changes to your benefits.

Final coverage and reimbursement are determined by your insurance provider after your claim is processed.

This means that while we aim to make our estimates as accurate as possible, we cannot guarantee that your estimate will be an accurate reflection of your out-of-pocket costs.

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. Any costs not covered by insurance are 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, 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 (e.g., there may be a lifetime maximum versus an annual amount), so make sure you're familiar with the details of your coverage before starting treatment.

Not always. Coverage percentages apply based on remaining benefits available.

Most plans have an annual maximum. Once that’s reached, you’re responsible for the full cost of any additional treatment, even if your plan lists partial coverage.

You may still have out-of-network benefits, and we can provide an estimate based on your plan. However, these estimates are less precise because we have limited visibility into how your insurance reimburses out-of-network care.

Final reimbursement is determined by your insurance provider.

You can either pay in full up front and receive reimbursement directly from your insurance or, in some cases, split your payment. This means paying part upfront and the rest after your claim is processed.

In many cases, reimbursement is sent to you, not to us. Regardless of what your insurance covers, you are responsible for the full cost of your treatment.

Not always. Many specialists are out-of-network, even if they accept the same insurance provider as your general dentist. This means coverage and reimbursement can vary.

Orthodontic coverage is handled differently than in other specialties. Some plans include orthodontic benefits, but they’re often limited; many cover only patients under 18, and adult coverage is less common.

We can help review your benefits and provide an estimate, but it’s important to confirm how your plan covers specialist care before starting treatment.

Estimates rely on the information from your insurance at the time they are made, so if anything about your insurance changes between that time and the time you are reimbursed, your bill ight be different.

If you have any pending claims, whether with another provider or us, your available benefits might change once those claims are settled. Note that claims can take up to 45 days to process.

It is also possible that your insurance coverage details may change in the interim, affecting your final bill.

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.

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, 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, familiarize yourself with your coverage details 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 aim to make costs easier to understand. Before any treatment begins, our team will share an estimate of what may be covered by your insurance and what you may be responsible for, based on the information available at the time.

You can always check with your insurance provider to better understand your coverage and benefits. If you prefer, the Tend insurance team can review your plan for you and provide an estimate of what may be covered and what you may owe, based on the information available at the time. All we need is your carrier name and subscriber ID.

In some cases, out-of-network benefits may include coverage for preventive services like exams and cleanings, though coverage can vary by plan. Provide us with your insurance information, and we can review your benefits and share an estimate of what may be covered and what you may 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 accept your insurance. We accept most PPO plans, as well as most other plans, except DHMOs, Medicaid, Healthplex, and Emblem. Please note that specialists are generally out of network, with orthodontists occasionally being an exception, which may affect coverage and reimbursement.

For carriers with which we have a direct contract, pricing is based on negotiated rates. When out of network, we use our standard fees and apply the coverage percentages from your out-of-network benefits to estimate what you’ll owe.

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

To help make treatment more manageable, we offer flexible financing options to spread 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.

Many dental insurance plans cover two cleanings and exams per year, typically spaced about six months apart. These preventive visits are often fully covered, 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.

No, teeth whitening is not typically covered by dental insurance, since it’s considered a cosmetic treatment rather than a necessary procedure. If you’d like, we can review your specific plan with you. Your Tend care team will also walk you through your options and share 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.

Often, 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.