We accept and bill all dental insurances (i.e., Delta Dental, Guardian, Metlife, Aetna, Cigna) except Medi-Cal. However, we are out-of-network for all dental insurances. Kind Heart Dental is a fee-for-service dental office, which means we have set fees for procedures based on the time required for the procedure and the amount of materials used to complete the procedure.
Unfortunately, dental insurances are able to decide by themselves how much each procedure is “worth.” They do not take into account all of the expenses that we incur to treat each patient (employee payroll, dental materials used in a procedure, personal protective equipment required by all employees, instrument sterilization costs, required employee training/continuing education, facility rent, utility bills, etc.). Based on your specific insurance plan, your insurance company has agreed to pay a certain percentage of their set fee for cleanings, fillings and crowns, but not the fee set by Kind Heart Dental.
Here is an example of how this works:
- You need a filling, and your insurance pays 80% of fillings.
- The insurance company has decided that this filling is worth $100. They will pay 80% of $100, which is $80.
- Our fee for this filling is $120. We will bill your insurance for the $80 and your portion will be $40.
- If you went to an in-network provider, that provider has agreed to accept the discounted fee of $100, receiving $80 from your insurance company and $20 from you.
The Advantages of Out-of-Network Care
While network status may be a determining factor for many individuals looking for a new dentist, we would like to explain why we have remained out of network.
By being an in-network provider, Kind Heart Dental would be agreeing to the insurance companies’ heavily discounted reimbursement rates. At the current dental insurance reimbursement rates, we would need to overbook our schedule in order to cover all of our costs. This would decrease the amount of time we can spend with each patient, make all appointments feel rushed, overwork our team and overwork our dentist. It often causes employees to cut corners and break protocol in order to stay on schedule. All of these have the potential to lead to patient safety events. The mission of our office is to provide comprehensive dentistry to all ages with a focus on compassionate, quality care, patient safety and evidence-based dental materials/products. We strive to provide the highest quality dental care with integrity, respect and kindness.
You will notice that many private practice dental offices are starting to pull out of networks for this exact reason. It is a difficult choice to make as a provider, but dental insurance benefits continue to decline and no longer allow dentists to practice to their true values.
If you do not have dental insurance, we offer membership plans that can be paid on a monthly basis and offer discounts for restorative procedures. We also accept CareCredit® which allows you to finance your dental work either short term (6-12 months) interest free or long term (24-60 months) at a reduced APR.
If you have any questions about dental insurance, your benefits and how this may affect you as a patient, please feel free to call our office at (805) 928-3928. We would be happy to speak with you and help you make an informed decision about your dental care in Santa Maria, California.