We are happy that you have dental insurance coverage to assist you in paying for
dental services. Here are some informational points for your reference:
- Your dental plan is designed to SHARE in your dental care costs. It may not cover
the total cost of your treatment.
- 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.
- 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 these levels.
- Some other factors that may affect reimbursement: least expensive alternative minimum
treatment, pre-existing conditions, treatment exclusions, annual maximums, deductibles,
- If you have double insurance coverage, this may not mean that you have 100% coverage.
Secondary insurers vary in their coordination of benefits.
- Although we may estimate your insurance benefit for services rendered, it is just
that, an estimate. There may be a residual balance after the insurance company pays.
- Claim processing schedules vary with each insurance carrier. You can help expedite
this process by replying promptly to any insurance inquires and calling the insurance
company regarding claim status on any services not paid within 45 days.
- When you come to our office for your first visit or if your dental insurance plan
changes, please bring your insurance card and any benefit booklet or completed claim
form you may have received.
To get the most benefit out of your dental insurance plan, follow guidelines below:
- Yearly Maximum. This is the maximum amount of money that your dental insurance plan
will pay for your dental work within one year. Although the maximum varies between
insurance companies, the average is around $1,000 a year, for each person underneath
the plan. This renews each year (on the first of January if your plan follows a
calendar year), providing another $1,000 for the next 12 months. If you have unused
benefits from the previous year, they won’t rollover to the next year. Get your
money’s worth and utilize your maximum in s given year - schedule an appointment
- Deductible. 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. Again,
the amount varies between insurance companies and their plans, and could be costly
if you choose an out-of-network dentist. If you have already paid your deductible
for this year and still do not believe you need to see the dentist, think again:
your deductible will start again next year.
- Premiums. 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.
- Do Not Avoid Problems. If you decide to delay treatment for what might be a simple
cavity, you risk a more extensive and expensive treatment down the line. You may
think that your simple toothache is nothing of consequence, when it is actually a
cavity waiting to worsen into a root canal.