While most PPO dental insurance types are accepted by Dr. Toksoy | Studio Dental NY at our Gramercy Park, Manhattan, NY location please call us to verify if you do not see your insurance plan listed below. Your insurance plan may require a payment (copayment or estimated patient part) during your appointment (date of service). Dental insurance is unfortunately not a guarantee that all of the dental treatments may be covered. Once the patient is about to reach or has used up their benefits for the year, they will be able to make a payment for the remaining balance out of pocket in order for all outstanding dues to be paid.
Annual Maximums: Your insurance gives you an annual maximum for the year. This amount is what they pay towards any dental services (even cleanings) in a year. Once they’ve paid this amount, they will no longer help cover any services until the maximum resets. Usually this is based on a calendar year and will renew the following calendar year. Until then you are welcome to get procedures as per your need at an office cost.
Frequency Limits: Every plan has its own rules about how often it will help cover services. For example, some plans allow cleanings at any time- twice a year, and some will allow them exactly six months apart. Limits are also set on how often the insurance will cover treatments such as crowns, fillings, and x-rays.
Downgrades: Most insurance plans will use the cost of silver fillings and crowns on back teeth; not tooth colored restorations, therefore when a doctor does a tooth colored filling it is downgraded and insurance payments come from the downgraded fee schedule. This allows the insurance to reimburse less money, as the materials for silver cost less. If your plan “downgrades” your treatment, you’ll be responsible for the difference in the cost.
Exam Limits: Insurance plans typically allow two exams a year. If you need to come in for an emergency exam in addition to your dental wellness exams, we are more than happy to help you, however your insurance may not pay for the third exam.
Payment of benefits are subject to all terms,
and exclusions of the member’s contract at the time of service. The payment is only an estimate and not 100% guaranteed.