Dental Insurance Information

What is Changing?

We are changing our relationship with dental insurance companies. Illume Dental will be considered unrestricted or out-of-network (OON) providers. That means we are not restricted to insurance limitations. We have found being an in-network provider does NOT allow us to provide ideal treatment that patients deserve. We will continue to maximize your benefits and file your claims as usual. Most insurance plans include OON benefits, which will still cover a portion of your treatment costs at our office. If your plan does not include OON benefits, you may consider our in-office membership plan.

Our Patients

At Illume Dental of McKinney, our patients are our priority and the reason we do what we do. Providing top-quality care is increasingly costly, involving significant investment in training, materials, equipment, and time. If we adhered strictly to insurance reimbursement rates, we would have to reduce the quality of care, shorten appointments, and see more patients per day, which we refuse to do.

Unlike insurance-driven practices, we ensure ample time for each patient to provide thorough and unhurried care.

Our Team

Our dedicated team of hygienists, assistants, and administrators is essential to our success at Illume Dental of McKinney. Due to the rising cost of living and inflation, we are committed to ensuring our excellent employees are properly compensated. Despite these increasing costs, insurance reimbursements have decreased.

We care deeply about our team and strive to offer them competitive benefits, bonuses, and salaries. Additionally, we want our team to have ample free time to enjoy with their friends and families and to appreciate the beautiful area we call home.

Our Practice

Patients choose Illume Dental of McKinney because of our exceptional providers, dedicated team, and the way we run our practice. Our vision statement: “We are a team committed to providing the highest quality of care to each and every patient. We build long-lasting relationships with patients by actively listening to their needs and desires and tailoring the experience and outcome to each patient as an individual. We are here to provide life-changing smiles.”

Our Values

These qualities matter to us at Illume Dental of McKinney, not to dental insurance companies. We refuse to compromise our clinical care to meet the demands of insurance companies. To provide ideal treatment and to remain true to our values, we must step away from the inequitable relationship of being an in-network office.

What if my insurance doesn’t have any OON benefits?

Maximizing Your Insurance Benefits

If your insurance offers little or no out-of-network (OON) benefits, consider asking your insurance carrier or employer to enhance these benefits. Doing so can increase the coverage you receive at our office. Many patients have left their previous dentist because they “stopped taking their insurance.” Having OON benefits provides you with greater flexibility and choice in selecting a dental office with minimal cost changes.

While improving medical coverage can significantly increase monthly costs, the cost difference between dental plans is relatively small. If there’s a significant increase in monthly premiums, many dental practices, including ours, offer membership plans. We offer our In-Office Membership Plan, which can be more financially beneficial for many patients compared to most private dental plans available.

How much will my dental care be now?

With thousands of different insurance plans available, it’s difficult to provide a broad answer about coverage, as insurance companies often create confusion for both patients and offices. The table below provides examples of in-network versus out-of-network benefits. Some plans may offer less coverage for out-of-network offices, depending on the specifics of the plan. However, most dental insurance plans can provide OON benefits if requested.

If you want to know how this change will specifically affect your plan, we are here to help. We can provide you with a basic breakdown of your plan’s out-of-network coverage. Please email us at info@illumedental.com, and allow a few days for a response, as we anticipate a high volume of requests.

Do You offer financing options?

When finances may prevent patients from accepting recommended dental treatment, we offer third party financing.

What questions should I ask my insurance about my OON coverage?

Our dental team verifies that your plan is active and collects basic benefit information from the insurance company in order to submit claims and calculate estimated copays, but it is ultimately the patient’s responsibility to understand the benefit and network restrictions of their specific dental insurance plan. We highly advise our patients to familiarize themselves with the details of their dental insurance plan. Below are some of the questions we feel are important for patients to ask their insurance company:

  • What are my out of network benefits?
  • What’s annual max & deductible – and what types of services does my deductible apply to?
  • What are the coverage percentages for: preventive, basic, major, implant?
  • How frequently will my plan cover: cleanings, exams, xrays?
  • What is my “plan year” (when does my plan reset each year)?
  • Is there a “waiting period”?
  • Is there a “missing tooth clause”?
  • Are there any material downgrades?
  • Is assignment of benefit to the provider accepted for out of network providers?
  • What is the maximum allowable charge for X, Y & Z codes if I were to see an out-of-network provider?
  • Ask for specific fees for different common dental procedures or the one you are interested in most.
  • Below are some Codes/Fees:
    • D1110 – Prophylaxis (dental cleaning)  – $138
    • D0120 – Periodic Exam – $80
    • D0210 – Full Series X-ray – $198
    • D0274 – Four Bitewing X-rays – $98
    • D2391 – 1-Surface Filling – $276
    • D2740 – Porcelain Crown – $1701
    • D2950 – Build-up (often required with a crown) – $325
    • D7210 – Surgical Extraction –  $410
  • **Your annual maximum benefit applies to ALL services. Once you reach this limit, your insurance will not cover ANY additional services, including cleanings and exams, until your plan year resets.

Why take the chance of potentially paying more to see us when you could easily find another in-network provider?

Our fees are aligned with regional averages, considering the local cost of living, making them highly comparable to other out-of-network (OON) offices. Operating a dental practice involves significant overhead costs. We take pride in using top-quality materials, advanced technologies, and our exceptional team of clinicians and administrators. Our commitment is to spend ample time with our patients, not rush through appointments.

Increasingly, in-network providers are facing the choice of cutting expenses or seeing more patients in less time. Many privately owned practices are transitioning towards becoming out-of-network (OON) offices to maintain quality care standards.

Are there changes to your pricing?

We want to be as transparent as possible. That's why we're committed to providing as much information as possible regarding our transition to out-of-network providers.

Pricing - Dental Care Treatments

*Prices may change and are specific to patient needs