Accepted Insurance · Out-of-Network

Anthem Prime — Out-of-Network Dentist in South San Francisco

We still see Anthem Prime patients. Here's how reimbursement works at our office, and what to expect at your first visit.

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Out-of-network with Anthem Prime — what that means for you

Anthem Prime is one of the Anthem tiers we are out-of-network with. We still see Anthem Prime patients — your plan may offer partial reimbursement under out-of-network benefits. Call us to verify your specific coverage before treatment.

Practically: your visit cost is the same as a private-pay visit at our published UCR fees. Your plan typically reimburses you a portion of those fees after we submit the claim on your behalf. The exact reimbursement depends on your plan's annual maximum, deductible, and out-of-network percentage — we are happy to call your insurance with you before any major treatment so there are no surprises.

How it works

How insurance works at our office

Three simple steps before your first visit.

  1. 01

    Step 1

    1. Call us with your insurance card

    Have your plan ID and group number handy. We verify your tier, benefits, deductible, and annual maximum directly with the carrier.

  2. 02

    Step 2

    2. We provide a written estimate before treatment

    For any major procedure (crown, implant, Invisalign) we send a pre-authorization to your insurer and walk you through the breakdown of what is covered and what your patient responsibility will be.

  3. 03

    Step 3

    3. We file the claim on your behalf

    After your visit we submit the claim to Anthem Prime electronically. You receive partial reimbursement under your plan's out-of-network benefits.

Services typically covered

Coverage grades vary by plan — these are common dental insurance categories. Call us to confirm your specific benefits.

Preventative (typically 100%)

Cleanings, exams, X-rays, fluoride. Most PPO plans cover preventative care fully when you stay in-network.

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Basic (typically 70–80%)

Fillings, simple extractions, deep cleanings, root canals. Patient responsibility is the remaining share after insurance.

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Major (typically 40–50%)

Crowns, bridges, dentures, dental implants. Many plans have an annual maximum that caps total payouts each calendar year.

Learn more

Common questions about Anthem Prime

Does Westborough Dental Care accept Anthem Prime?
We are out-of-network with Anthem Prime, but we still see patients with this plan. Your visit cost is the same as a private-pay visit, and your plan may reimburse you a portion after we file the claim. Call (650) 873-6681 to verify your specific benefits.
Are you in-network for HMO plans?
No — we are PPO-only. We are not contracted with any HMO dental plans. If you have an HMO plan, your insurance will likely not cover services at our office. Please contact your insurance to find an in-network HMO provider, or call us to discuss our self-pay or membership plan options.
Will my plan cover cleanings, fillings, or crowns?
Most dental PPO plans cover preventative care (cleanings, exams) at 100% in-network, basic care (fillings, extractions) at 70–80%, and major care (crowns, bridges, implants) at 40–50%. There is typically an annual maximum — once you reach it, additional treatment is patient-responsibility. We provide a written breakdown before any major treatment so there are no surprises.
What if I have a copay or deductible?
Your deductible is the amount you pay out-of-pocket each plan year before insurance starts contributing. Your co-pay or co-insurance is your share at the time of service. We collect any patient responsibility at the visit and file the claim with Anthem Prime for the insurance portion.

Have Anthem Prime? Let's verify your coverage.

Call us at (650) 873-6681 with your insurance card handy. We will check your tier, benefits, and annual maximum directly with the carrier — usually in under 10 minutes.

Call (650) 873-6681