Dental Insurance Hillsboro | Payment Options | East Wind Dental Care

Making Dental Care Affordable and Accessible in Hillsboro, Oregon

At East Wind Dental Care, we believe that financial concerns should never stand between you and the dental care you need. Our Hillsboro dentist practice works with most major dental insurance providers and offers flexible payment options to ensure every patient can receive quality care. Whether you have PPO insurance, are considering financing options, or need care without insurance, our team is committed to helping you navigate your options and maximize your benefits. Call us today at (503) 614-0198 to discuss your insurance coverage and payment options.

Insurance Overview

East Wind Dental Care is proud to accept most PPO dental insurance plans, making it convenient for Hillsboro families to use their existing coverage at our practice. Unlike HMO plans that restrict you to specific networks, PPO plans offer the flexibility to visit the dentist of your choice while still receiving substantial benefits. Our experienced administrative team handles insurance verification, claim submission, and benefits coordination on your behalf, minimizing paperwork and maximizing your reimbursement. We file claims electronically for faster processing and work directly with your insurance company to ensure you receive the coverage you’re entitled to. As an in-network provider with several major carriers and an out-of-network provider for others, we can typically accept your plan regardless of your specific coverage. Our commitment is to make the insurance process seamless so you can focus on your dental health rather than administrative details.

Insurance Plans We Accept

Our Hillsboro dental office accepts a wide range of dental insurance plans to serve our diverse patient community. We are in-network providers for several major carriers and gladly accept out-of-network PPO plans as well. Major insurance providers we work with include:

Major Carriers:

• Delta Dental PPO (in-network provider)
• Cigna Dental PPO
• Aetna Dental PPO
• MetLife Dental
• Guardian Dental
• United Healthcare Dental
• Humana Dental PPO
• Blue Cross Blue Shield Dental
• GEHA Dental
• Principal Dental
• Ameritas Dental
• Renaissance Dental
• Lincoln Financial Dental

Additional Coverage:
We also accept dental coverage through Medicare Advantage plans that include dental benefits, as well as standalone dental plans purchased through the healthcare marketplace. Federal employee plans (FEHB), state employee plans (PEBB), and union dental plans are welcome at our practice.

Not Sure About Your Plan?
Our administrative team is happy to verify your benefits before your appointment. Simply call our office at (503) 614-0198 with your insurance information, and we’ll confirm your coverage, explain your benefits, and provide an estimate of your out-of-pocket costs for any planned treatment. We can also check whether we’re in-network with your specific plan and what that means for your coverage levels.

Out-of-Network Benefits:
Even if we’re not contracted as an in-network provider with your insurance company, you can still use your PPO benefits at East Wind Dental Care. We’ll submit claims on your behalf, and your insurance will reimburse you directly or allow assignment of benefits to our office based on your plan’s out-of-network provisions.

How Dental Insurance Works

Understanding your dental insurance helps you make informed decisions about your care and maximize your benefits. Here’s a comprehensive breakdown of how dental insurance typically works:

Annual Deductibles:
Most dental plans require you to pay a deductible before insurance coverage begins. Deductibles typically range from $25 to $100 per person per year. Once you’ve met your deductible, your insurance begins covering services according to your plan’s benefit structure. Some plans waive the deductible for preventive care, meaning cleanings and exams are covered from day one.

Annual Maximums:
Dental insurance plans typically have an annual maximum benefit, usually between $1,000 and $2,000 per person per year. This is the total amount your insurance will pay for dental care in a calendar year. Once you reach this maximum, you’re responsible for 100% of any additional costs until the next benefit period begins. It’s important to note that annual maximums haven’t increased significantly since the 1960s, despite the rising cost of dental care, which is why many patients reach their maximum when extensive treatment is needed.

Coverage Levels by Service Category:

Preventive Care (Type I):
Typically covered at 80-100% with no deductible. Includes routine cleanings (usually two per year), comprehensive exams, routine X-rays, and fluoride treatments for children. These services are designed to prevent dental problems and are the most generously covered.

Basic Restorative Care (Type II):
Usually covered at 70-80% after deductible. Includes fillings, simple extractions, periodontal therapy (deep cleanings), and emergency treatment. These services address existing problems before they become more serious.

Major Restorative Care (Type III):
Typically covered at 50% after deductible. Includes dental crowns, bridges, dentures, root canal treatment, and surgical extractions. These more extensive procedures have lower coverage percentages but are essential for restoring oral health.

Orthodontic Care (Type IV):
When included, usually covered at 50% with a separate lifetime maximum (often $1,000-$2,000). Not all plans include orthodontic coverage, and it may only be available for patients under 19.

Waiting Periods:
Many dental insurance plans impose waiting periods for certain services, particularly if you’re newly enrolled. Preventive care is usually available immediately, but basic services might require a 3-6 month wait, and major services could have a 6-12 month waiting period. Pre-existing condition clauses may also apply.

Plan Frequency Limitations:
Insurance plans limit how often certain procedures are covered. For example, most plans cover two cleanings per calendar year or one every six months, one set of bitewing X-rays per year, and crowns on the same tooth only once every five years.

Maximizing Your Benefits

Getting the most value from your dental insurance requires strategic planning and understanding of your coverage. Here are expert tips for maximizing your benefits:

Use Your Preventive Benefits:
Since preventive care is typically covered at 100%, there’s no reason not to use your two annual cleanings and exams. Regular preventive visits help catch problems early when they’re less expensive to treat and often prevent the need for major procedures entirely. Skipping preventive care to “save” your benefits actually costs you money in the long run.

Understand Your Annual Maximum:
Keep track of how much of your annual maximum you’ve used throughout the year. If you’re approaching your maximum and need additional work, consider whether any treatments can wait until the next benefit period when your maximum resets. However, don’t delay necessary treatment, as dental problems typically worsen over time and become more expensive to fix.

Plan Major Treatment Strategically:
If you need extensive dental work that will exceed your annual maximum, work with our team to create a treatment plan that spreads procedures across two benefit years when possible. For example, if you need multiple crowns, we might complete some before December 31st and others after January 1st, allowing you to use two years of benefits.

End-of-Year Considerations:
As the calendar year ends, remember that your benefits don’t roll over. If you haven’t used your annual maximum or your preventive care visits, consider scheduling treatment before December 31st. This is especially important if your plan has a deductible that resets each year. Additionally, if you’ve already met your deductible for the current year, you’ll get more value from treatment before it resets.

Verify Benefits Before Treatment:
Always have our team verify your benefits before major procedures. Insurance coverage can change, and knowing your out-of-pocket costs in advance helps you plan financially and avoid surprises.

Consider Timing for New Coverage:
If you’re changing jobs or enrolling in new coverage, understand when your benefits begin and what waiting periods apply. You may want to complete needed treatment under your current plan before switching.

Coordinate Benefits:
If you have dual coverage (such as through both your employer and your spouse’s employer), we can help coordinate benefits to maximize your coverage. One plan serves as primary and the other as secondary, potentially covering costs that your primary plan doesn’t.

Financing Options

East Wind Dental Care offers multiple financing solutions to make dental care affordable, even for procedures not fully covered by insurance or for patients without insurance. Our goal is to ensure that cost never prevents you from receiving the treatment you need.

CareCredit Healthcare Credit Card:
CareCredit is our most popular financing option, offering flexible payment plans for dental treatment. This healthcare credit card can be used for your entire family and is accepted at over 250,000 healthcare providers nationwide.

Benefits of CareCredit:

• Promotional 0% interest financing for 6, 12, 18, or 24 months on purchases of $200 or more (with approved credit)
• Extended financing options up to 60 months for larger treatment plans
• Quick online application with instant decisions
• Use for multiple procedures over time
• No annual fee
• Manage your account easily through their mobile app

How It Works:
Apply online at carecredit.com or in our office. Once approved, you can use your account immediately for treatment. Choose a promotional period that fits your budget, and as long as you pay off the balance within the promotional period, you’ll pay no interest. Monthly payments are required during the promotional period.

LendingClub Patient Solutions:
For larger treatment plans or longer financing terms, we also offer LendingClub Patient Solutions, which provides fixed-rate loans specifically designed for healthcare expenses.

LendingClub Features:

• Loan amounts from $1,000 to $100,000
• Terms from 24 to 84 months
• Fixed interest rates (no surprises)
• No prepayment penalties
• Simple online application process
• Fast approval and funding

In-House Payment Plans:
For patients who prefer not to use third-party financing, East Wind Dental Care offers flexible in-house payment arrangements on a case-by-case basis. We work with you to create a payment schedule that fits your budget while allowing you to proceed with necessary treatment.

In-House Plan Details:

• Available for treatment plans over $500
• Typically requires a down payment of 25-50%
• Remaining balance divided into monthly payments
• Usually 3-6 month payment terms
• No interest when paid according to schedule
• Automatic payment options available

Discussing Your Options:
During your treatment planning consultation, our financial coordinator will review all costs, explain what your insurance will cover (if applicable), and present financing options that work for your situation. We provide written estimates before treatment begins and never proceed without your approval and full understanding of the financial arrangements.

HSA & FSA: Using Health Savings Accounts

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are excellent ways to pay for dental care with pre-tax dollars, effectively giving you a discount on all dental expenses.

Health Savings Accounts (HSA):
If you have a high-deductible health insurance plan, you may be eligible for an HSA. These accounts allow you to set aside pre-tax money for qualified medical and dental expenses. HSA funds roll over year to year, so you can build a healthcare nest egg for future needs. Most dental services qualify for HSA payment, including cleanings, fillings, crowns, orthodontics, and even cosmetic procedures in some cases.

Flexible Spending Accounts (FSA):
FSAs are employer-sponsored accounts that let you contribute pre-tax dollars for healthcare expenses. Unlike HSAs, FSA funds typically must be used within the plan year or you lose them (though some plans offer a small rollover or grace period). This makes FSAs perfect for planned dental treatment.

Qualified Dental Expenses:
Both HSAs and FSAs cover most dental services, including preventive care, restorative procedures, periodontal treatment, oral surgery, orthodontics, and dentures. Some cosmetic dentistry procedures may also qualify if they’re medically necessary.

Using Your Account at East Wind Dental Care:
We accept HSA and FSA debit cards just like regular credit cards. You can also pay out-of-pocket and submit a claim for reimbursement to your account administrator. Our team provides detailed receipts with all the information needed for your claims.

Payment Methods Accepted

East Wind Dental Care accepts a variety of payment methods to make it convenient for you to pay for your dental care:

Payment Options:

• Cash
• Personal checks
• Credit cards: Visa, MasterCard, Discover, American Express
• Debit cards
• CareCredit healthcare credit card
• HSA and FSA cards
• Electronic funds transfer (for payment plans)
• Online bill pay through our patient portal

Payment Policies:
Payment is due at the time services are rendered unless other arrangements have been made in advance. For patients with insurance, we collect your estimated out-of-pocket portion at the time of service. If your insurance pays more than estimated, we’ll refund the difference. If they pay less, we’ll bill you for the remaining balance.

Payment Plans:
For larger treatment plans, we can arrange payment terms before beginning treatment. This allows you to budget for care while receiving the treatment you need without delay.

We accept payment in person at our office, over the phone for balances and payment plans, or through our secure online patient portal for your convenience.

Treatment Cost Estimates

Transparency in pricing is important to us. We believe you should know what to expect before receiving treatment so you can make informed decisions about your dental care.

Pre-Treatment Estimates:
Before beginning any major treatment, we provide a detailed written estimate that includes:

• The specific procedures recommended
• The cost for each procedure
• What your insurance is expected to cover (if applicable)
• Your estimated out-of-pocket responsibility
• Available payment and financing options

Insurance Pre-Authorization:
For major procedures, we can submit a pre-authorization (also called a pre-determination or pre-treatment estimate) to your insurance company. This allows them to review the treatment plan and provide a written explanation of what they will cover before we begin work. While not a guarantee of payment, it gives you a clear picture of your benefits and financial responsibility.

Clear Communication:
Our financial coordinator is available to discuss costs, answer questions about your insurance coverage, and help you understand all financial aspects of your treatment. We never want cost to be a surprise, and we never begin major treatment without your full understanding and approval of the financial arrangements.

Typical Costs Without Insurance:
While costs vary based on individual needs, typical ranges for common procedures include:

• Routine cleaning and exam: $200-$350
• Deep cleaning (per quadrant): $200-$300
• Composite filling: $200-$400
• Porcelain crown: $1,200-$1,800
• Root canal therapy: $800-$1,500
• Extraction: $200-$500

These are general ranges, and your specific cost will be provided in your personalized treatment estimate.

No Insurance? No Problem!

Many Hillsboro dentist residents don’t have dental insurance through their employer or can’t afford individual dental insurance premiums. If you’re among the millions of Americans without dental coverage, East Wind Dental Care has created an affordable solution.

East Wind Dental Care Membership Plan:
Our in-house dental membership plan provides comprehensive preventive care and significant savings on all dental treatment for one low annual fee. It’s an alternative to traditional insurance that’s often more affordable and provides better value, especially for routine and preventive care.

Membership Benefits:

• No waiting periods, no deductibles, no annual maximums
• Significant discounts on all procedures beyond preventive care
• No claim forms or pre-authorizations
• Family-friendly pricing with special rates for children
• Acceptance at our practice with no network restrictions

Adult Membership: $299 per year includes:

• Two professional cleanings
• Two comprehensive exams
• All necessary X-rays (bitewings, panoramic, or full-mouth series as needed)
• Emergency exam (if needed)
• 15% discount on all other dental treatment

Child Membership: $199 per year includes:

• Two professional cleanings
• Two comprehensive exams
• All necessary X-rays
• Fluoride treatments
• 15% discount on all other dental treatment

Learn More:
Visit our Dental Membership Plan page for complete details, savings examples, and enrollment information. The membership plan typically saves patients hundreds of dollars annually compared to paying out-of-pocket for individual services.

Frequently Asked Questions About Insurance & Payment

1. Do you accept my dental insurance?
We accept most PPO dental insurance plans. Call our office at (503) 614-0198 with your insurance information, and we’ll verify your coverage and explain your benefits. Even if we’re not in-network with your specific plan, we can still file claims for out-of-network benefits.

2. What’s the difference between in-network and out-of-network coverage?
In-network providers have contracted rates with insurance companies, which often means lower out-of-pocket costs for patients. Out-of-network providers don’t have contracted rates, so insurance may cover a smaller percentage, though you still receive benefits. We’ll help you understand exactly what your plan covers at our office.

3. How much will my treatment cost?
We provide detailed cost estimates before beginning any major treatment. The cost depends on the specific procedures needed and your insurance coverage (if applicable). Our team will give you a written estimate of your out-of-pocket responsibility before you commit to treatment.

4. Do you file insurance claims for patients?
Yes, we file all insurance claims on your behalf as a courtesy. We submit claims electronically for faster processing and can track claim status to ensure proper payment. You don’t need to handle any paperwork.

5. What if my insurance doesn’t cover the full cost?
If your insurance doesn’t fully cover your treatment, we offer several payment options including CareCredit financing, LendingClub loans, and in-house payment plans. Our goal is to make care affordable regardless of your insurance coverage.

6. Can I use CareCredit for any treatment?
Yes, CareCredit can be used for any dental treatment at our office, from routine cleanings to major procedures. It’s especially helpful for treatments not fully covered by insurance or for patients without insurance.

7. What happens if I don’t have dental insurance?
Patients without insurance are welcome at East Wind Dental Care. We offer a dental membership plan that provides preventive care and treatment discounts for one affordable annual fee. We also offer financing options to make care accessible.

8. Do you accept HSA and FSA cards?
Yes, we accept Health Savings Account (HSA) and Flexible Spending Account (FSA) cards for payment. Most dental services qualify for HSA/FSA payment, allowing you to use pre-tax dollars for your care.

9. What’s your payment policy?
Payment is due at the time of service unless other arrangements have been made in advance. For patients with insurance, we collect your estimated out-of-pocket portion at time of service and bill or refund any difference once insurance processes the claim.

10. How do I maximize my dental insurance benefits?
Use your preventive benefits (cleanings and exams) fully each year, understand your annual maximum, and plan major treatment strategically to utilize benefits across calendar years when possible. Our team can help you develop a treatment plan that maximizes your insurance benefits. Don’t forget to use benefits before they expire at year-end, as they don’t roll over.

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Schedule Your Appointment Today

Don’t let insurance questions or payment concerns prevent you from getting the dental care you need. Contact East Wind Dental Care at (503) 614-0198 to discuss your insurance coverage, explore payment options, or learn about our dental membership plan. Our experienced team is here to help you navigate the financial aspects of dental care so you can focus on achieving optimal oral health.

East Wind Dental Care
Hillsboro, Oregon
Phone: (503) 614-0198

We’re committed to making quality dental care accessible and affordable for every member of your family.