Can I use my American dental insurance in Tijuana?

Posted by Melissa Gonzalez on May 21 2020, 09:49 AM

Can I use my American dental insurance in Tijuana?

We’ve all been there. You pay your dental insurance month after month and when you need a dental treatment, it turns out that your copayment is much higher than you can comfortably afford right now. But oh well, what option do you have?

Turns out that you DO have an option! Plenty of dentists in Tijuana are certified to work with American insurances!

How do I know if my dental insurance is accepted in Tijuana?

You have a couple of options to find this out:

·        Your insurance provides you with a dentist list. Your insurance can give you or your employer a list of certified dentists who accept your insurance. These lists often include addresses and phone numbers too, sometimes even websites. There’s a section in these lists that detail if your insurance is accepted outside of USA.

·        Look it up in an internet search engine. You can also simply look up your insurance and the keywords “accepted in Tijuana”. Many dentists have neat lists of the insurances they work with in their websites.

·        Ask your coworkers and friends. There’s nothing like first-hand experience, take advantage of it! Ask your coworkers and friends with your same insurance if they have used it in Tijuana. Chances are they will even recommend you a specific dentist!

How does my insurance work in Tijuana?

Now that you know that your insurance is accepted by Tijuana dentists, the next step is to call one and find out how insurances are handled by them. Each clinic works differently with insurances depending on the insurance type (HMO or PPO) so we will make a generalization of the most common cases:

·        Obtaining eligibility. Ideally you should call your dentist before setting an appointment so you can provide them with your information and they will obtain your eligibility. This information usually is:

o  Full name of the subscriber

o  Date of Birth of the subscriber

o  ID Number, Member ID or any number that distinguishes you as a subscriber. You can usually find it in your Insurance Card. If you don’t have it, you would have to provide your Social Security Number.


Once your dentist has this information, they will get in contact with your insurance in order to obtain your eligibility. This means they will know which procedures are covered and at which rate, so they can give you a plan treatment estimate during your first appointment.


·        Deductibles in procedures. In the case of Basic and Major treatments such as cavity fillings, root canal treatments or extractions, you will be charged a deductible. This is a once-a-year payment that “activates” your insurance that year. You can handle it as a personal deductible or a family deductible, depending on how many members of your family you wish to have treated. The amount will depend on your insurance plan, the most common amounts are $50 dlls per individual and $150 dlls per family, but it might be higher or lower depending on the plan you have.


·        Copayments in procedures.Depending on your plan coverage, some treatments might not be fully covered by your insurance. This means that you will have to pay an amount of the total cost of the treatment. The benefit of using your insurance in Tijuana is that these copayments will be considerately lower than in USA, so a $600 dlls copayment back home could be as low as $100 dlls in Tijuana, or even lower!


·        Claims filing and handling. Once the procedures are done, your dental clinic will handle the insurance claim for you. You won’t have to worry about ADA codes or teeth numbering, your dental clinic will handle that hassle for you. Depending on your type of insurance, this

Keep in mind that these points might differ from clinic to clinic, it’s best to call your preferred dentist to make sure of how they will handle your insurance. For example, some dentists charge you their full cost and file the claim so your insurance reimburses you directly their covered percentage, or they might give you the tools to make the claim yourself.

Tips and Tricks to use your insurance in Tijuana

·       The best way to know they’re certified is to see them in your insurance’s provider list.

·       Have your Member card at hand when setting an appointment, you will need it to obtain your eligibility. If you have dependents, keep their date of birth in mind too.

·       If you know your yearly deductible, bring enough cash to cover it in case you decide to have a basic or major procedure done in that appointment. This might save you another trip!

·       Bring some spare cash (around $200 dlls) in case you need to make some copayments. If you don’t use it with your dentist, perhaps you can enjoy some other things that Tijuana has to offer!


So, why spend more money in copayments when you could have your dental treatment done for less? Call Dental Studio and make an appointment now!

Have you compared copayment amounts between Tijuana and USA dentists?  Leave your experience in a comment below!

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Calle Quinta , Zona Centro
Tijuana Baja California, 7974

Tijuana Dental Studio

Calle Quinta , Zona Centro

Tel: (619) 955-6901

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