Understanding Your Dental Insurance:
Most insurance plans group dental insurance into three categories:
1. Preventative and Diagnostic – Usually covered at 100 percent and includes cleanings and exam twice a year, a set of bitewing x-rays once a year, panoramic/full mouth x-rays once every 3-5 years. For children under the age of 14, fluoride treatments and sealants may be covered also at 100percent.
2. Basic – Usually covered at 80 percent and subject to a once a year renewable. The deductible usually ranges between $25 and $100 per year per person. Basic procedures often include fillings, root canals and oral surgery.
3. Major – Usually covered at 50 percent and also requires a deductible. Major procedures are prosthetic and include dentures, crowns, bridges, and implants.
How your insurance and deductible work:
Under most insurance plans, preventative and diagnostic is covered at 100 percent with no deductible required. Insurance companies are willing to pay a 100 percent of preventative and diagnostic because they realize that if they catch a problem such as a cavity early it will cost them a lot less than if it spreads and you have to have major work done. By paying for dental x-rays once a year and teeth cleanings twice a year, the insurance company reduces the chance that you will develop serious problems down the road. As the treatment expense increases from preventative and diagnostic to major, the amount your insurance will cover drops. Also, basic and major services usually require a deductible before a calculation of benefits is determined.
A yearly maximum is the maximum amount of money that an insurance company will spend on you per year. Yearly maximums usually range from $1000 to $3000 and are based on the agreement between your employer and the insurance company. Most yearly maximums renew each year beginning January 1st, but it is also not uncommon for a plan to renew on the employee's hire date. If you do not use your entire maximum for the year it does not roll over to the following year. Yearly deductibles also renew on the same date as your yearly maximum.
Once diagnosed for treatment, it is recommended that you have the problem treated as soon as possible, but if you need to have a lot of work and can’t afford to have it all done at once, you can utilize your benefits for two years.
Reasonable and Customary Rates:
If your dental benefits are based on reasonable and customary rates, that means your insurance company has a fee schedule for your plan. Fee caps vary from insurance plan to insurance plan and company to company. The amount of money your employer is willing to pay toward your dental benefits will determine the appropriate fee caps for your plan. It is a good idea to call your insurance company and request a fee schedule for your plan if you do not have one. Fee schedules are a statistical way of calculating how much an insurance company can allocate to certain procedures without losing profit based on the amount of money they receive from an employer.
Insurance companies do not release fee schedules to dental offices; otherwise they risk losing hidden money. It is nearly impossible for a dental office to give you an exact amount that your insurance company will pay, because we do not have access to fee schedules.
As a courtesy to our patients, we will file your insurance claim for you.
We are in-network with the following insurance companies:
We are not a DMO or a DHMO provider. Unfortunately, at this time we do not participate in the Medicare/Medicaid Program.