Mill Mountain Dentistry By Opulent Dental in Roanoke, VA accepts and files MetLife, Aetna, Cigna, and most other commercial and private dental insurance plans. How much your plan pays depends on whether it is a PPO or an HMO-style plan, your deductible, your annual maximum, and the type of care you need.
Plans we accept and file include Anthem Blue Cross, Guardian, Cigna, Lincoln Financial Group, Delta Dental, Aetna, MetLife, GEHA, Ameritas, Principal, and UnitedHealthcare. If you have a Delta Dental plan, its networks work a little differently. Below is a plain-language guide to how these plans work and how to check your coverage before a visit.
PPO or HMO: Why Does Your Plan Type Matter?
Most dental insurance falls into one of two types, and the difference decides where you can go and how much you pay.
PPO plans
A PPO (preferred provider organization) plan lets you choose your dentist. Dentists in the plan's network agree to reduced fees. You can usually still use your benefits with other dentists, although your share of the cost may be higher because the office has not agreed to the plan's fee schedule.
HMO-style plans
A dental HMO, sometimes called a DHMO, assigns you to a network dentist and uses a set copay schedule. Several large insurers offer this type alongside their PPO plans; Aetna calls its version a DMO, and Cigna's is called Cigna Dental Care. These plans generally do not pay for routine care outside your assigned office.
Your member ID card or plan documents will say which type you have. If the card mentions an HMO, DHMO, or DMO, check with your insurer before booking with a new office.
What Do Most Dental Plans Cover?
Commercial dental plans usually sort care into three classes and pay a different percentage for each. Exact numbers vary by plan, but this is a common setup:
| Service class | Common examples | Typical plan share |
|---|---|---|
| Preventive | Exams, cleanings, routine X-rays | Often 100% |
| Basic | Fillings, simple extractions, often root canals | Often 70-80% |
| Major | Crowns, bridges, dentures, implants if covered | Often 50% |
Some plans list root canal treatment as a basic service and others as a major one, which changes your out-of-pocket cost. Plans also set frequency limits, such as two cleanings a year, and may only pay to replace a crown after a set number of years.
Deductibles, Annual Maximums, and Waiting Periods
- Deductible: what you pay before the plan shares the cost of basic and major care, often around $50 per person each year. Preventive visits are frequently exempt.
- Annual maximum: the most the plan pays in a plan year, commonly between $1,000 and $2,000. Larger treatment can reach this limit quickly.
- Waiting period: individual policies in particular may wait 6 to 12 months before paying for basic or major care.
- Missing tooth clause: some plans will not pay to replace a tooth lost before your coverage began, which can affect bridges, implants, and dentures.
How Can You Check Your Coverage Before a Visit?
- Have your member ID card ready, including the group number and the subscriber's name and date of birth.
- Note whether your plan is a PPO or an HMO-style plan.
- Log in to your insurer's member site or call the number on the card to confirm your deductible, remaining annual maximum, and any waiting periods.
- Ask about frequency limits for cleanings, X-rays, and crowns.
- For larger treatment, ask about a pre-treatment estimate so you know what the plan expects to pay before work begins.
Bring your card to your appointment so the claim can be filed with the right plan.
What About Dental Savings Plans?
Not every dental card is insurance. Dental savings plans, also called discount plans, give members reduced fees at participating offices instead of paying claims. With this type of plan you pay the discounted fee at the visit, and there is usually no annual maximum or waiting period.
Why Use Your Benefits Before They Reset?
Many dental plans renew on January 1. Unused annual maximums usually do not carry over, and deductibles start again, so fall is a good time to schedule cleanings that are due or treatment you have been postponing. Spreading larger treatment across two plan years can also make better use of two annual maximums.
No Insurance or Not Fully Covered?
If your plan does not cover everything, or you do not have dental insurance, our office accepts CareCredit, offers in-house payment plans, and has a VIP Membership savings plan. Learn more about dental insurance and financing options in Roanoke.
Frequently Asked Questions
Do you accept MetLife dental insurance?
Yes. We accept and file MetLife dental plans, along with Aetna, Cigna, Guardian, Ameritas, and most other commercial and private dental insurance. Your exact coverage depends on your plan.
Is your office in-network with my plan?
Network participation depends on the specific plan and can change over time. Call our office or your insurer with your member ID to confirm how your plan treats visits to our office.
What is the difference between a PPO and a DHMO?
A PPO lets you choose your dentist and pays part of the cost in or out of network. A DHMO assigns you to a network dentist, uses set copays, and generally does not pay for routine care elsewhere.
Does dental insurance cover crowns and root canals?
Most plans pay part of the cost. Root canals are often a basic service and crowns a major service, commonly covered at about 50% after the deductible, subject to your annual maximum.
What should I bring to my first visit?
Bring your insurance card, a photo ID, and a list of any medications you take. Contact our office before your visit if you have questions about your benefits.
Medically Reviewed By
Dr. Priyanka Dutt, DDS, is the Founder and Clinical Leader of Opulent Dental, overseeing clinical standards and patient care across all Opulent Dental offices, including Mill Mountain Dentistry By Opulent Dental in Roanoke.
Insurance & payment options
Dental Insurances and Finances
At Mill Mountain Dentistry By Opulent Dental, we understand that patient finances are important, so we accept and are able to file most commercial and private dental insurances.
Plans we accept and file include Anthem Blue Cross, Guardian, Cigna, Lincoln Financial Group, Delta Dental, Aetna, MetLife, GEHA, Ameritas, Principal and UnitedHealthcare. Coverage depends on your plan, so call +1 540-769-6370 with your insurance information if you have questions about your benefits.
- CareCredit accepted
- In-house payment plans
- VIP Membership savings plan
- No dental insurance? No problem