THE INS AND OUTS OF DENTAL INSURANCE
THE INS AND OUTS OF DENTAL INSURANCE
Dental insurance gets more confusing every year, even for those of us who work with it every day! Approximately 65% of employers offer some type of dental insurance coverage. There are also several companies that offer individual dental insurance plans. We are here to help you understand how your insurance plan can help you cover the cost of your dental care. Below is a list of the dental insurance companies we are contracted with. If your dental insurance is not listed, that does not necessarily mean you will not have coverage in our office! Please give our office a call and we will be more than happy to decipher the coverage your plan will provide for you at our office!
WE PARTICIPATE IN THE FOLLOWING DENTAL INSURANCE NETWORKS:
Anthem Blue Cross/Blue Shield 300 Level Providers
Cigna Dental PPO
Delta Dental Premiere – Contact us if your plan is a PPO plan
Humana Dental PPO
Humana Gold – This is the Medicare Dental Option
Met Dental – Limited in network option – Contact Us!
We are NOT contracted with Medicaid, any of the state plans, or any HMO designated plan.
Retiring soon? Contact us with questions you may have in regards to Medicare Dental plan options! Some companies also offer an option to continue Dental coverage under Cobra plans, we can help you determine the cost effectiveness of that option. Many dental insurance options come at a cost that could be more expensive than paying for your care out of pocket.
We offer a 10% courtesy discount for our uninsured patients when they pay at the time of service, this could be your best option!
Call us with any questions you may have!
How Well Do You Know Your Dental Insurance?
Have you ever really thought about the answer to that question? If you haven’t you are not alone. Many patients typically are not in tune with how their dental claims are paid or what their plans pay for. The items listed below are just a few little snags your employer or the insurance carrier do not explain to you, the insured.
- Annual Maximums: This is the highest dollar amount that your dental plan will pay during your benefit year. Most dental plans run on a calendar year Jan-Dec, however there are other plans that run on a benefit year which may be different. Any costs that rise above your annual maximum will be considered out of pocket for you.
- Preferred Providers: This term means one thing, if you see a dentist within the preferred network, which solely means they are in their network (participating dentist). If you get dental care from someone who is not in the network, your costs out of pocket will be greater.
- Pre-Existing Conditions Clause: Your dental insurance may have a missing tooth clause. For example replacing a tooth that was extracted prior to you enrolling in the dental plan benefits will not be paid.
- Coordination of Benefits or Non-Duplication of Benefits Clause:(Applies only if you carry dual insurance with your spouse): Even though you may have two dental plans there is no guarantee that all of the plans will pay for your treatment. Every insurance company handles the coordination in its own way, it is best to discuss this with both of your insurance companies for details.
- Frequency Limitations: Your dental insurance will limit the number of times it pays for certain treatments. However this should never dictate your treatment. For example, a cleaning and exam may be covered twice per plan year or once every six months (which means it MUST be six months to the date in order to receive the benefit). Be aware of how your plan plays so that you can receive the maximum benefit from your insurance.
- Not Dentally Necessary: Your insurance carrier may claim that a procedure is not dentally necessary and will not be covered. If this is the case it does not mean that the treatment was not needed. Never allow your insurance to dictate what is necessary, only you and your dentist should be making that decision. If your insurance denies treatment, you can appeal the claim.
- Downgrading: This is what your insurance company will do to reduce their cost. They may downgrade on certain treatments. For example, you may want a filling done with a composite (white) material but your insurance will only pay for a silver filling leaving the difference an out of pocket expense for you.
- Least Expensive Alternative Treatment Clause: When there are two ways of treating a condition the plan may only pay for the least expensive option. However this may not always be the best option. For example: your dentist may recommend a bridge to replace a tooth, but your plan may only pay for a partial denture.
*Always Remember that although you might be tempted to make a decision based on what your insurance will pay, remember that your health is the #1 priority. Take the time to discuss the best possible options regarding your care so that you can keep your teeth for a lifetime!