CJ Henley, DMD, PA / San Marco, Jacksonville, Florida
Dental insurance and payment in Jacksonville, FL.
We’re out of network. Here’s what that means for you.
Our San Marco office in Jacksonville is out of network with every dental insurance plan. That doesn’t mean your insurance is useless here. Many PPO plans still pay part of the cost, and our team will help you understand how to use your benefits. You’re responsible for what the plan doesn’t pay, and you get the fee in writing before treatment starts.
- In writingyour fee for each step, before treatment starts
- 47%of Medicare beneficiaries had no dental coverage in 20191
- 59%of Medicare Advantage enrollees with a yearly cap on broader dental benefits had a cap of $1,000 or less in 20211
- 1 dentistDr. Henley sees every patient himself
Top-rated on Google: 4.9 stars from more than 225 patient reviews.
Do you take my dental insurance?
The plain answer: we’re out of network.
We don’t have a contract with any dental insurance company. If you have a PPO plan with out-of-network benefits, it may still pay part of your care here. If you have an HMO or DHMO plan, it usually won’t. Either way, you get the fee in writing first and decide from there.
When people ask “do you take my insurance?” they usually mean “will my insurance help pay for this?” The second question is the one that matters.
Being in network means a dentist has signed a contract with an insurance company and agreed to its fee schedule. We haven’t signed those contracts. So we set our own fees, and your plan decides how much of them it will pay under your out-of-network benefits. Whatever the plan doesn’t pay is your responsibility.
What that means in practice
- You can still use a PPO plan. Many PPO plans pay something toward out-of-network care. How much depends entirely on your plan.
- Your share may be larger than it would be in network. Plans often pay less, or calculate payment differently, when you see an out-of-network dentist. We’d rather you know that up front.
- You know our fee first. You get it in writing for each step before treatment starts, and our team will help you understand how your benefits are likely to apply.
Why we’re out of network
It comes down to how we want to practice. Dr. Henley sees every patient himself, with no rotating associates, and a new patient visit runs about two hours so nothing gets rushed. Every crown and porcelain veneer is handmade by a local ceramist instead of milled in the office. That kind of time and lab work is hard to fit inside a contracted fee schedule, so we chose not to sign one. Plenty of good dentists are in network. This is just how we’ve chosen to run one small office.
PPO out-of-network dentist
How PPO out-of-network benefits usually work.
Most PPO plans pay out-of-network care based on their own “allowed amount,” not the dentist’s fee. They apply a deductible, pay a percentage that depends on the type of service, and stop paying once you hit your annual maximum. Frequency limits, waiting periods, and downgrades can reduce what they pay. Every plan is different, so check yours.
Allowed amount (UCR)
Plans figure out-of-network payment from their own number, often called the usual, customary, and reasonable (UCR) fee, allowed amount, or maximum plan allowance. If the plan’s number is lower than the dentist’s fee, the plan pays its percentage of its own number, not of the fee.
Coinsurance
Many plans pay a higher percentage for preventive care like exams and cleanings, a lower one for fillings, and less again for major work like crowns. Some plans pay a lower percentage out of network than in network. Your plan summary lists the percentages.
Deductible
The amount you pay each year before the plan starts paying for certain services. Many plans waive it for preventive care. Some have a separate out-of-network deductible.
Annual maximum
The most the plan will pay in a benefit year. Once you reach it, you pay the rest of that year’s care yourself. Unused amounts usually don’t roll over.
Frequency limits
Plans limit how often they pay for a service: a certain number of cleanings or exams per year, X-rays at set intervals, a crown on the same tooth once every several years.
Waiting periods
Some plans don’t pay for basic or major services until you’ve been enrolled for a set time. Many also have a missing tooth clause that won’t pay to replace a tooth lost before your coverage began.
Downgrades (alternate benefit)
Many plans have an alternate benefit clause. They pay for a less costly option even when you and your dentist choose another one. A common example is paying a tooth-colored filling on a back tooth at the rate for a silver filling. You can still choose the other treatment; the plan just pays less.
Balance billing
An in-network dentist generally agrees to accept the plan’s contracted fee for covered services. An out-of-network dentist hasn’t agreed to that, so the difference between the fee and what the plan pays is billed to you. That’s normal out of network.
HMO, Medicare, and medical insurance
Plans that usually don’t pay out of network.
HMO and DHMO dental plans generally pay only when you see a dentist in their network, so they usually won’t help here. Traditional Medicare doesn’t cover routine dental care. Medicare Advantage dental benefits vary widely by plan. We don’t bill medical insurance.
HMO and DHMO dental plans
With a dental HMO (often called a DHMO), you typically choose or are assigned a dentist inside the plan’s network, and the plan pays only for care there. Most of these plans don’t have out-of-network benefits. If your card says HMO, DHMO, or “prepaid,” ask the plan whether it pays anything out of network.
Medicare
Original (traditional) Medicare generally doesn’t cover routine dental care like cleanings, fillings, extractions, or dentures. It may pay for certain dental services that are directly tied to other covered medical treatment, or that you get as a hospital inpatient. You pay all costs for services Medicare doesn’t cover.2
Medicare Advantage plans are different. Most offer some dental coverage, but what they cover varies a great deal. In a 2021 KFF analysis, the most common coinsurance for fillings, extractions, and root canals in those plans was 50%, and most enrollees with broader dental benefits had an annual dollar cap.1 Many Medicare Advantage dental benefits also work through a network, so ask your plan whether it pays anything out of network. If you’re approaching retirement, our retirement and dental insurance page goes into more detail.
Medical insurance
We don’t bill medical insurance. That includes dental care connected to cancer treatment. If you think your medical plan might cover part of your dental care, ask the plan directly what it needs from you.
Out-of-network dental insurance in Jacksonville
In network, out of network, and no insurance, side by side.
The main difference is who sets the fee. In network, the insurance company’s contract does. Out of network, the dentist does, and the plan pays its share based on its own allowed amount. With no insurance, you pay the dentist’s fee directly, with no annual maximum or plan rules involved.
| In-network dentist | Out-of-network dentist (like us) | No dental insurance | |
|---|---|---|---|
| Who sets the fee | The plan’s contracted fee schedule | The dentist | The dentist |
| What the plan pays | A percentage of the contracted fee | A percentage of the plan’s allowed amount, if the plan has out-of-network benefits | Nothing |
| Your share | Your coinsurance and deductible on the contracted fee | The full fee minus what the plan pays | The full fee |
| Annual maximum, frequency limits, downgrades | Apply | Apply | Don’t apply |
| HMO or DHMO plans | Pay only for in-network care | Usually pay nothing | Not applicable |
| Choice of dentist | Limited to the network | Any dentist you choose | Any dentist you choose |
| Fee before treatment | Varies by office | Here, in writing before treatment starts | Here, in writing before treatment starts |
How to check your dental benefits
Questions to ask your plan before your visit.
Call the member services number on your insurance card, or log in to the plan’s website, and ask about out-of-network benefits specifically. The answers to the questions below will tell you most of what you need to know about what your plan is likely to pay at our office.
Note the date and a reference number for the call. Plans from the same company can differ a lot.
Your checklist
- Do I have out-of-network benefits? If the answer is no, the plan won’t pay toward care here.
- How do you calculate out-of-network payment? Ask whether they use a UCR fee, an allowed amount, or the in-network fee schedule.
- What percentage do you pay out of network for exams and cleanings, for fillings, and for crowns and other major work?
- What is my deductible, and is there a separate out-of-network deductible? Has any of it been met this year?
- What is my annual maximum, how much is left, and when does the benefit year reset?
- What are the frequency limits on exams, cleanings, X-rays, periodontal maintenance, and crowns? When were my last ones paid?
- Do I have any waiting periods or a missing tooth clause?
- Does my plan have an alternate benefit (downgrade) clause, for example on tooth-colored fillings or crowns on back teeth?
- Can I get a predetermination (a pre-treatment estimate) for larger work, and how long does it take?
Bring what you learn when you call us. Our team can help you read it against your treatment plan, and you’ll still get our fee in writing before anything starts. A plan’s estimate isn’t a promise of payment, so treat it as a guide.
For a longer explanation, see what patients should know about out-of-network dental insurance.
New patients in San Marco
How fees and insurance work at our office.
Call with your plan details before your first visit. At your new patient visit, Dr. Henley examines you and explains what he finds. You get the fee for each step in writing before treatment starts. You decide what to do, and you’re responsible for whatever your plan doesn’t pay.
Call with your plan details
Have your insurance card handy when you call 904.398.1549. Our team can talk with you about fees, how your benefits are likely to apply, and payment arrangements.
Come in for your new patient visit
It runs about two hours: a health and medication review, a comprehensive exam, X-rays only when needed, an oral cancer screening, and a cleaning planned around what your gums need. See new patients for what to bring.
Talk through what Dr. Henley found
He explains what he sees, what’s urgent, and what can wait. If there’s more than one option, you’ll hear the trade-offs.
Get the fee in writing
Before any treatment starts, you get the fee for each step in writing. Take it home and compare it with your benefits.
Decide
When it’s safe to wait, some people spread treatment across two benefit years. Dr. Henley will tell you when something shouldn’t wait.
Dentist without insurance in Jacksonville
No dental insurance, and paying with an HSA or FSA.
You don’t need dental insurance to be a patient here. Without a plan, you pay our fee directly, with no annual maximum, frequency limits, or downgrades in the way. HSA and FSA funds can generally be used for dental treatment, though cosmetic care like teeth whitening generally doesn’t qualify.
If you don’t have dental insurance
People end up without a dental plan for all sorts of reasons. Some retire and lose employer coverage. Some look at the premiums and annual maximums and decide to set the money aside instead. Either way, you get the same exam, the same time with Dr. Henley, and the same written fee before treatment starts. Call our team to ask about fees and payment arrangements.
If you’re weighing whether to buy an individual dental plan, especially around retirement, read retirement and dental insurance. It compares the options in more detail.
What affects the fee
We don’t publish fees, because the right treatment depends on what we find. What changes the fee: the number of teeth involved, whether you need a regular cleaning or periodontal treatment, whether X-rays are needed, the materials and lab work for crowns and veneers, and whether you choose sedation. You’ll see all of it in writing first.
HSAs and FSAs
Health savings accounts (HSAs) and health flexible spending arrangements (FSAs) can generally be used for qualified medical expenses, and the IRS counts dental care among them.3,4 IRS Publication 502 lists cleanings, sealants, fluoride, X-rays, fillings, braces, extractions, and dentures as includible, and says teeth whitening is not.3 FSA plans set their own rules, so check with your administrator.
Frequently asked questions
Questions about dental insurance and payment.
Where can I find an out-of-network dentist in Jacksonville?
CJ Henley, DMD, PA is an out-of-network general dental practice at 3675 Hendricks Avenue in San Marco, Jacksonville. Many PPO plans still pay part of the cost of care here, and our team will help you understand how to use your benefits. Call 904.398.1549 with your plan details or request an appointment.
Do you take my dental insurance?
We’re out of network with every dental plan, so we don’t have a contract with any insurance company. If your plan has out-of-network benefits, it may still pay part of your care. You’re responsible for what the plan doesn’t pay, and you get the fee in writing before treatment starts. Call our team with your plan details to ask about fees and payment arrangements.
Do you take Delta Dental, Cigna, Aetna, Blue Cross Blue Shield, Humana, or MetLife?
We’re out of network with all of them. That said, many PPO plans from these and other companies still pay part of the cost when you see an out-of-network dentist. How much depends on your specific plan, not just the company name. Call your plan and ask about out-of-network benefits, then call us at 904.398.1549.
Will my PPO plan pay anything if you’re out of network?
Often, yes, but it depends on the plan. Many PPO plans pay a percentage of their own allowed amount for out-of-network care, after your deductible and up to your annual maximum. Some pay less out of network than in network. Use our benefits checklist when you call your plan.
Why didn’t my plan pay what I expected?
The usual reasons are an allowed amount lower than the dentist’s fee, an unmet deductible, a reached annual maximum, a frequency limit, a waiting period, or a downgrade clause that pays for a less costly option. Your plan’s explanation of benefits should say which one applied.
I have a DHMO or HMO dental plan. Will it pay here?
Usually not. Dental HMO plans generally pay only for care from dentists in their network, and we’re not in any network. Some cover limited emergency care elsewhere. Call the plan to ask. If you’d like to be seen here anyway, you’d pay our fee directly and get it in writing first.
Does Medicare cover dental care?
Original Medicare generally doesn’t cover routine dental care such as cleanings, fillings, extractions, or dentures, with narrow exceptions tied to certain medical treatment. Medicare Advantage plans often include some dental coverage, but benefits, networks, and annual caps vary widely. See retirement and dental insurance.
Can I use my HSA or FSA at your office?
HSA and FSA funds can generally be used for dental treatment such as exams, cleanings, fillings, crowns, and extractions. Teeth whitening and other purely cosmetic care generally don’t qualify under IRS rules. Check with your plan administrator about your account’s rules, and ask a tax advisor if you’re unsure.
Do you bill medical insurance?
No. We don’t bill medical insurance for any care, including dental care related to cancer treatment. If you think your medical plan might cover part of your dental treatment, ask the plan directly what it requires.
I don’t have dental insurance. Can I still be seen?
Yes. You don’t need a dental plan to be a patient here. You pay our fee directly, without plan limits like annual maximums or frequency rules. You get the same two-hour new patient visit and the same written fee before treatment starts. Call our team to ask about fees and payment arrangements. More on our FAQ page.
Your next step
Call us with your plan details.
Have your insurance card in hand, or just tell us you don’t have a plan. We’ll talk through how your benefits are likely to work here, answer questions about fees and payment arrangements, and get you scheduled with Dr. Henley at our San Marco office.
CJ Henley, DMD, PA3675 Hendricks Avenue
Jacksonville, FL 32207
Prefer a nonurgent text? 904.762.5616 is our practice on-call and text line. Please don’t send sensitive health information by text, and call for anything urgent.
Related pages
Sources
- Freed M, Ochieng N, Sroczynski N, Damico A, Amin K. Medicare and Dental Coverage: A Closer Look. KFF. July 28, 2021.
- Centers for Medicare & Medicaid Services. Dental services. Medicare.gov. Accessed October 2026.
- Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses. Accessed October 2026.
- Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans. Accessed October 2026.