Sometimes we hear that our patients are more than a little confused by all the ins & outs of their dental insurance policies.
If you’re a little clueless about how dental insurance works, or by which services are covered and which ones aren’t, let’s see if we can shed some light on the issue.
As we recently discussed in this post, most dental insurance policies expire annually – which means that if you don’t maximize your benefits by using all of the funds available for dental treatment, you lose them altogether!
Individual dental insurance coverage depends on your particular plan, we just thought we’d highlight some of the general guidelines for understanding how dental insurance works.
Frisco TX dentist Dr. Manjula Alapati and the rest of the team here at our New Smiles Dental Excellence office know that by helping you understand how dental insurance works, can help you make sure that you are getting the treatment you need, and taking advantage of all of the available benefits.
So let’s dive in to how dental insurance policies work.
What Is a Copay?
A dental insurance copay is the fixed amount specified by your insurance policy that you must pay toward your dental visits.
Copays are required either at the time of your visit or when you receive a bill for the dental treatment you have received – depending on how your particular policy works.
What Is a Deductible?
A deductible is the annual amount that you must pay before your insurance starts covering your dental treatment costs.
Understanding your deductuble amount is of the utmost importance when considering how dental insurance works, and which type of plan is best for you and your needs.
Some people simply need to see visit our office twice a year for routine checkups & teeth cleanings. And some other people require more frequent office visits to address more pressing dental health concerns.
Understanding how your dental insurance works, and especially understanding your deductible & copay will help you maximize coverage while limiting out of pocket costs.
What Dental Treatments Does Your Insurance Cover?
Dental insurance coverage differs from plan to plan, important variables like deductibles, covered treatments, & annual out-of-pocket maximums should all be considered before choosing which option is best for you and your family.
It is common for dental insurances to offer what are known as “100-80-50” plans. What does this mean? It’s shorthand for:
- 100% of preventive and diagnostic services, including semi-annual checkups, cleanings, and x-rays.
- 80% of medically necessary work such as fillings and root canals.
- 50% toward crowns, bridge work, and other procedures.
But remember, this is only an overall approximation and your dental insurance plan certainly may offer more (or less) benefits.
Your best bet is to check your policy for the specific details of your dental insurance or flexible spending account plan.
What’s the Difference Between “In-Network” and “Out-of-Network”?
Here are New Smiles Dental Excellence of Frisco, we are in-network with the following dental insurance policies:
- Blue Cross Blue Shield
- Delta Dental
- United Healthcare
When insurance companies negotiate contracts with specific dentists (or group practices) they then offer discounts to their patients, these dentists are what is considered to be in-network with that particular insurance plan.
However, patients are not obligated to only see an in-network dentist, even if it may be the more cost-effective option – and remember, sometimes cheaper isn’t always better…especially when we’re talking healthcare.
Out-of-network dentists are just that, they are not part of your dental insurance plan and therefore most likely do not offer any discounts or cost savings related to your particular insurance policy.
However, since most insurance plans differ in coverage, choosing an out-of-network dentist may give you access to more services and treatment options.
If you have any questions about which dental insurance plans we work with here, please ask us about your particular insurance. We can help you determine whether we are in-network or out-of-network for your provider and what exactly that means for your dental treatment plan.
What If I Don’t Have Insurance?
In addition to our $49 New Patient Exam, X-Rays & Teeth Cleaning Special, for your convenience we also offer (4) in-house dental plans you can view here: http://newsmilesfrisco.com/insurance/
For each of our insurance plans, you’ll pay a certain amount of money per year in exchange for different services at discounted rates. The plans start at only $100 per year, and all of them include at least one exam and 2 cleanings.
At New Smiles of Frisco, we know that you aren’t necessarily rolling in extra money.
If you’ve been avoiding going to the dentist to save money, you’ve given damage and decay more time to build up.
You may be thinking that there’s no way you’ll be able to afford all of the expensive dental procedures that you need, so you just avoid the dentist even longer.
Frisco TX Dentist Helps You Maximize Your Dental Insurance
At New Smiles Dental Excellence of Frisco we are contracted with all major PPO insurance carriers and few DMO insurances.
If you already have dental insurance, you’ll probably never pay a penny when you come to see us for regular, preventive procedures.
Please bring your insurance information with you to your first appointment so that we can maximize your reimbursement.
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This post originally appeared on the dental health blog of Dr. Frank Maldonado, and has been republished here with permission.