United Concordia dental plans offer several options – including Concordia Preferred (Active PPO), Concordia Flex (Passive PPO), Concordia Plus (Dental HMO), and Smile for Health Value Plans – which provide different levels of coverage for dental procedures. However, it’s important to note that services considered strictly cosmetic in nature are typically excluded from coverage under most plans.
Disclaimer:
Pacific Dental & Implant Solutions is not an insurance provider, and all information provided regarding dental coverage is based on our experience working with these plans. Plan details, coverage limitations, and benefit structures can change at any time. While our Billing department is happy to work with you on maximizing your plan coverage and benefits, we encourage all patients to refer to their specific plan documentation or contact your dental insurance provider directly for the final determination regarding coverage. Insurance verification by our team is provided as a courtesy, but ultimate responsibility for understanding your benefits lies with you as the policyholder.
United Concordia Dental Coverage Overview
As an in-network provider for United Concordia dental insurance in Honolulu, Pacific Dental & Implant Solutions is committed to helping patients maximize their dental benefits and understand their coverage options. Our experienced team works directly with United Concordia to ensure seamless billing and comprehensive care for our patients.
Want help understanding your exact coverage and benefits?
Schedule a free insurance verification with our team, and we’ll break down your specific United Concordia Dental benefits before you begin treatment.
Network Status
Pacific Dental & Implant Solutions is a fully credentialed United Concordia participating provider, which means our patients enjoy significant advantages when using their United Concordia dental insurance. By choosing our practice, patients benefit from:
- Streamlined claims processing
- Negotiated in-network rates
- Direct insurance verification
- Simplified out-of-pocket cost calculations
Our team can quickly verify your specific United Concordia plan details and help you understand your coverage before any procedure, ensuring transparency and helping you make informed decisions about your dental care.
Coverage Limits
United Concordia dental plans offer varying levels of coverage with annual maximums typically ranging from $1,000 to $1,500. Some plans feature the Annual Maximum Rollover, allowing qualifying members to roll over unused benefit dollars. Our practice assists patients in understanding their unique coverage, including:
- Preventive services typically covered at 100%
- Basic procedures often covered at 80%
- Major treatments usually covered at 50%
- Potential benefit rollovers for qualifying members
We recommend scheduling a pre-treatment consultation where our insurance specialists can provide a detailed breakdown of your expected coverage and potential out-of-pocket expenses.
Waiting Periods
United Concordia dental plans may implement specific waiting periods, depending on your plan type. These waiting periods are designed to manage comprehensive treatment access:
- Preventive services are typically available immediately
- Basic procedures may have varying waiting periods
- Major treatments like crowns and bridges may require longer waiting periods
Our patient care coordinators can help you navigate these waiting periods and develop a strategic treatment plan that aligns with your insurance benefits and oral health needs.
What Cosmetic Dental Procedures Does United Concordia Dental Insurance Cover?
United Concordia dental insurance provides targeted coverage for medically necessary dental procedures, with varying levels of benefits across different plan types. Understanding your specific plan’s details is crucial for maximizing your dental care coverage.
Dental Implants
United Concordia dental plans generally provide limited coverage for dental implants. Coverage varies by specific plan type, with some plans excluding implant body placement and surgical procedures altogether. However, the restorative crown associated with an implant may be covered as an alternate service, subject to the plan’s frequency and service limitations. Our office can help you understand the specific coverage details of your United Concordia plan and explore the most cost-effective treatment options.
Dental Crowns
Crown coverage through United Concordia dental plans varies by plan type. Crowns are typically considered a major service covered at around 50% after deductibles. Coverage often requires crowns to be medically necessary rather than purely cosmetic. Most plans allow replacement of crowns only after a specified period (often 5-7 years) from initial placement. Porcelain and metal crowns may have different coverage levels, and some plans classify certain crown types as high-cost procedures, which may incur additional charges.
Dental Bridges
United Concordia dental plans provide bridge coverage as a major service, typically at the 50% coverage level after deductibles. Bridge replacements are usually available no sooner than five years after the initial placement, with specific restrictions on pontics and retainers. Some plans consider certain bridge components as high-cost procedures, which may affect your out-of-pocket expenses. Our team can provide detailed information about your specific coverage for bridge procedures.
All-On-Four
United Concordia dental insurance typically does not provide specific coverage for All-on-4 implant solutions. Most plans exclude comprehensive implant-based full-arch restorations. While individual components like dentures may be partially covered, the complete All-on-4 procedure would likely be considered an out-of-pocket expense. Our office can help you explore alternative treatment options that may have partial insurance coverage and develop a cost-effective treatment plan.
How to Use Your United Concordia Dental Insurance at PDIS
Pacific Dental & Implant Solutions provides comprehensive support for patients navigating their United Concordia dental insurance benefits, ensuring a transparent and straightforward approach to understanding and maximizing your coverage.
Verification Process
Our dedicated insurance team conducts a comprehensive verification of your United Concordia dental benefits before your initial appointment. We systematically review your specific plan type, examining the nuanced details of your coverage, including annual maximums, service limitations, and potential benefit rollovers. Our verification process involves detailed analysis of your plan’s specific provisions, such as copayment structures, waiting periods, and service category coverage. We carefully document your current benefits, ensuring you have a complete understanding of your insurance support before any treatment begins.
Pre-authorization Requirements
United Concordia dental plans may require prior authorization for several critical dental procedures, including crowns, periodontal services, and certain major treatments. Our experienced team manages the entire pre-authorization process, submitting comprehensive documentation that includes clinical records, radiographs, and detailed treatment plans demonstrating medical necessity. We handle all communication with United Concordia, preparing and submitting the required documentation. Our proactive approach provides you with clear insight into your expected coverage and potential out-of-pocket expenses.
Coverage Tiers and Network Details
As a fully credentialed United Concordia participating provider, Pacific Dental & Implant Solutions offers patients significant advantages through our in-network status. Depending on your specific United Concordia plan, coverage varies across different service categories. Preventive services like cleanings and routine examinations are often covered at the highest percentage, while basic and major procedures have incrementally increasing patient responsibilities. Our office handles all claims submission directly with United Concordia, ensuring a streamlined process that minimizes administrative burden for our patients. We work diligently to help you understand the intricate details of your dental insurance, providing transparent guidance to help you maximize your available benefits.
Understanding Your Out-of-Pocket Costs with United Concordia Dental Insurance
Pacific Dental & Implant Solutions is committed to helping patients understand the financial aspects of their United Concordia dental insurance coverage, ensuring transparency and minimizing unexpected expenses.
Deductibles
United Concordia dental plans feature varying deductible structures across different plan types.
Most PPO plans include an annual deductible, typically $50 per covered person for United Concordia Preferred and Flex plans. This deductible applies to basic and major services, with preventive care often exempted.
Our insurance specialists carefully verify your specific plan’s deductible requirements, ensuring you understand exactly how these costs will be applied to your treatment.
For patients with multiple dental insurance plans, we can help coordinate benefits to potentially reduce your out-of-pocket expenses.
Copayments and Coinsurance
United Concordia dental insurance utilizes a structured copayment system that varies by plan type and service category. Typically, patients can expect the following coinsurance ranges:
- Preventive services: 0-20% copayment
- Basic procedures: 20-50% copayment
- Major services: 50-80% copayment
The exact percentage depends on your specific plan type, with Concordia Preferred (Active PPO) and Smile for Health Value Plans offering different levels of coverage. Our team provides a detailed breakdown of your expected out-of-pocket costs before any treatment, helping you make informed decisions about your dental care.
Annual Maximums
United Concordia dental plans offer different annual maximum benefits across their plan options. Most individual plans feature annual maximums ranging from $1,000 to $1,500, with specific limitations based on plan type.
Some plans include innovative features like Annual Maximum Rollover, allowing qualifying members to roll over up to $300 of unused benefit dollars if they get at least one exam during the plan year and use less than 50% of their annual maximum.
Our insurance coordinators specialize in helping patients maximize their annual benefits, providing strategic treatment planning that optimizes your insurance coverage while addressing your comprehensive dental health needs.
Next Steps: Schedule Your Consultation
Ready to use your United Concordia Dental benefits at PDIS? Schedule a consultation below. When you visit, please bring along your insurance card and a valid photo ID. We also recommend preparing a list of your dental concerns and bringing any previous dental records you may have available.
Having these materials ready will help us provide the most comprehensive evaluation of your needs and insurance coverage. We look forward to serving you soon!