Understanding Dental Insurance
8 Tips and Tricks Patients Need to Know
Dental benefits are an excellent resource to assist with payment for some dental care. If you have coverage, the following information should be helpful.
- Your dental plan is designed to SHARE in your dental care costs. Do not expect it to cover the total cost of your entire treatment plan.
- Generally, a dental benefit plan is a contract between your employer, or plan sponsor, and the insurance company. These contracts vary widely.
- Your plan may want you to choose to receive your dental care from a list of their preferred providers. Whether or not you choose your dental care provider from this defined group may or may not affect your levels of reimbursement.
- While Dr. Karpovich will always recommend the most conservative treatment possible, your benefits may only cover the cost of the least costly alternative. Other limitations and exclusions specified by your plan may also limit what is paid regardless of what the plan typically covers.
- Our office may estimate benefits payable for specific services. Actual payment by the insurance company may vary and any balance will be your responsibility. Patients covered by two insurances may still have a balance for some services. Secondary insurers vary in their coordination of benefits.
- We ask that you arrive to your first visit with your active benefit card. If your carrier or plan changes please let our office know to avoid any delay in the processing of any claims.
- Please reply to any calls by our office about your insurance promptly. In the event a claim payment is delayed, an inquiry by you to the carrier is always appreciated.
- There is no regulation as to how insurance companies determine reimbursement amounts, resulting in wide fluctuation. In addition, insurance companies are not required to disclose how they determine reimbursement.
Dental Coverage Terminology 101
Here are a few insurance related terms we're sure you'll encounter. But do you know what they really mean?
If you are paying the premiums for your dental insurance each month out of the year, you should take advantage of your benefits. Even if you do not have a cavity and are not in need of a root canal, be sure to regularly schedule your dental cleanings. These cleanings, when maintained, help prevent and can detect early signs of cavities, gingivitis, oral cancer, and other dental issues. Regular cleanings and checkups are your “insurance” against most costly services!
This is the amount of money that your dental insurance plan will pay for your dental work within a specified plan period. Although the maximum varies between insurance companies, the average is around $1,250 a year, for each person covered by the plan. This renews each year. If you have unused benefits from the previous year, it is possible some benefits may rollover to the next year. Additionally, some insurance companies count what they pay to your provider for "free" cleanings against your maximum thereby decreasing the amount that may be contributed for other services performed. Check with your carrier to see if this is the case for your plan.
This is a term for the amount of money you have to pay your dentist—out of pocket—before your insurance company will pay to take care of your teeth. This is typically between $25 and $100 per person but also varies. Deductibles can be higher when seeing an out of network dentist. Like maximums, deductibles reset every plan year. In most cases, deductibles do not need to be paid to receive coverage for diagnostic and preventative services such as cleanings and exams. Again, the amount varies between insurance companies and their plans, and could be costly if you choose an out-of-network dentist.
The term covered services refers to procedures that your policy allows payment for. However, be advised, the insurer may not issue payment because of exclusions, limitations, or a maximum allowance instituted on your plan. It may be in your best interest to request a pre-authorization or pre-determination of benefits in this case. We understand that cost is sometimes a guiding factor when deciding between treatment options. It is for this reason we offer financing. We hope this will enable you to choose the most effective treatment regardless of coverage.