Paying for it
Yes. We take Medicaid.
It is the first thing many families ask and the last thing most practice websites answer. So it goes at the top: Ohio Medicaid managed care plans, CHIP, and most employer and marketplace PPO plans.
Ohio Medicaid & CHIP
In-network with the Ohio Medicaid managed care dental plans. No cap on how many Medicaid children we see, and no separate waiting list. Bring the card, or read the numbers to us over the phone.
Private dental plans
In-network with most employer and marketplace PPO plans, and able to bill out-of-network plans where we are not. We will tell you which of those you are before you book, not after.
Paying directly
Everything quoted in writing first. We will tell you what is urgent, what can wait, and what the cheaper honest alternative is when there is one.
Plan families we work with
- Ohio Medicaid managed care
- CHIP
- Delta-style PPO plans
- Employer PPO plans
- Marketplace paediatric dental
- Self-pay membership
Drawn as neutral shapes on purpose: we are not licensed to reproduce a carrier's trademark, and a logo wall on a demonstration site would imply commercial relationships that do not exist. Ring us for the current list of plans by name.
How the money part actually goes
Four steps, in this order, every time.
Before you book
Ring us with the card in your hand. Kelly checks eligibility while you are on the phone — plan name, member number, your child’s date of birth. It takes about four minutes.
At the check-up
A check-up, cleaning, varnish and any indicated radiographs are billed to the plan. For most children on Medicaid or a paediatric dental plan, that is the whole visit and there is nothing to pay.
If treatment is needed
We submit a pre-treatment estimate and wait for the plan to answer before we book. You get the real number in writing, not an approximation and not a surprise.
If something is not covered
We tell you what it costs, what the alternatives are, and honestly which parts can wait and which cannot. Nobody here will let a child’s treatment turn into a sales conversation.
EPSDT
What a child on Medicaid is covered for
Children's dental cover under Medicaid runs through EPSDT — Early and Periodic Screening, Diagnostic and Treatment — and it is broader than most adult cover people have experience of. Individual claims are still decided by the plan, which is why we check first, but this is the shape of it:
- Check-ups and examinations
- Cleanings
- Fluoride varnish
- Sealants on permanent molars
- Radiographs when clinically indicated
- Fillings
- Crowns and pulpotomies on baby teeth
- Extractions
- Emergency and trauma visits
- Space maintainers
Orthodontic treatment is covered only where it meets the plan's medical-necessity criteria. We screen at about age seven and refer; the orthodontist submits that assessment, not us. Read more about growth and orthodontic screening.
What to bring to the first appointment
- The insurance or Medicaid card — a photograph of it on your phone is fine.
- A list of medications, including anything over the counter and any inhalers.
- Your paediatrician's name, so we can write to them if anything needs joining up.
- Whatever comforts your child. A blanket, a toy, headphones, a specific song. It is not silly and it genuinely helps.
Money questions, answered straight
Do you really take Ohio Medicaid?
Yes. We are in-network with the Ohio Medicaid managed care dental plans and we take CHIP. We do not keep a cap on how many Medicaid children we see, and there is no separate, longer waiting list for them. Ring us with your card and we will check your specific plan before you come.
What does Medicaid cover for a child’s dental care?
Children on Medicaid are covered under EPSDT — Early and Periodic Screening, Diagnostic and Treatment — which is broader than most adult dental cover. In practice that means examinations, cleanings, fluoride, sealants, radiographs, fillings, crowns, pulpotomies, extractions, emergency care and space maintainers, when they are needed. The plan decides individual claims, so we check before we treat.
We have private insurance. Are you in-network?
We are in-network with most employer and marketplace PPO plans and we can bill out-of-network plans too, though your share will usually be higher. Give us the plan name when you ring and we will tell you honestly which category you fall into.
What if we have no cover at all?
Tell us. We quote everything in writing before it happens, we will tell you what is urgent and what can safely wait, and we offer a self-pay arrangement for families paying directly. A child in pain gets seen regardless of what is sorted out afterwards.
Why did my plan pay for my older child’s sealants and not my younger one’s?
Most plans limit sealants to specific teeth and specific ages, usually the permanent molars. If we recommend sealing a tooth outside those rules we will say so first and tell you the cost, so you can decide rather than discover.
Do you charge for missed appointments?
Not for Medicaid patients, and not for a first missed appointment for anyone. What we ask is a phone call — a slot given back in the morning is a slot a child in pain can have that afternoon.
Can I get a copy of my child’s records?
Yes, on request, and we will not make it difficult. Radiographs go to another practice electronically the same day if you are moving.
Not sure what you have?
Ring us with whatever card you can find. Kelly has seen every plan in the county and will tell you where you stand in about four minutes.