Dental insurance can be difficult to understand and the fine print can often become overwhelming. It is important to understand your benefits, your maximum allowance, deductible, as well as the frequencies and limitations. You can always talk to your dentist about your treatment, and our front desk would be happy to help answer any questions regarding your dental benefits, too. We always try our best to accommodate our patients and help you get the most out of your insurance, but ultimately, the financial responsibility for all dental treatment falls on the patient.
Your insurance policy will most likely allow for 2 cleanings and exams per year, but they must be 6 months and 1 day apart from each other. If you have already utilized your policy maximum (which typically ranges from $1,000 – $1,500) before your second cleaning, it will not be covered by insurance.
Your dentist may recommend a deeper cleaning based on your oral health and conditions. This cleaning would no longer be considered a “free” cleaning, but rather fall into a category of treatment called periodontal therapy. With this comes a different percentage of coverage and your deductible may apply.
Your periodic exam may share a frequency with an emergency exam. Should you be seen more than twice at our office, the third visit may be denied due to the frequency limitations.
The maximum allowable for Dental Insurance has not changed in 30 years! It was never meant to cover all of your recommended dental treatments. Instead, dental insurance was designed to be a tool to offset a portion of the cost of your care.
Your employer bought a dental plan based on what premiums were affordable to the employees and the company. An insurance plan will rarely cover 100 percent of all dental services.
There are several differences between your dental and overall health insurance, the purpose and focus for care is the largest of those. For both types of insurance, a deductible will most likely apply.
Your dental insurance contract is made between you, your employer, and the insurance company. These 2 parties negotiate coverage ahead of time without taking into account your individual health history. Your dentist may suggest services outside of your insurance plan because the dentist is focused on providing you with the care you need and deserve.
We try very hard to accommodate our patients and even hire extra people just to help the patients get the most out of their insurance. Ultimately, the financial responsibility for all dental treatment is the patient’s.
Your dentist is a specialist who works to diagnose, treat, and prevent oral health problems.
They have completed at least 8 years of schooling to become an expert in the prevention, diagnosis, and treatment of oral health problems. Their priority is to help you maintain good overall and oral health, while your dental benefits have nothing to do with your individual needs and oral health history. Your dental office has no influence in the negotiation of your insurance coverage and contract.
Dental plans often limit your options through a contract with your employer, Many services needed for your dental health may not be covered or have restrictions on the coverage. Your dental insurance is a contract negotiated between your employer and the insurance company providing the dental benefits, not your dental office.
Dental coverage has many limitations, such as missing tooth clauses (was your tooth extracted before your policy took effect?). Frequency limitations, (did you have a crown placed on that very same tooth less than 5 years ago?). There are instances when you may need to have a crown replaced a second time on the same tooth within a certain timeframe, and insurance may limit you to having that crown replaced only once every 5 years. X-rays, one might be needed based on something seen during the exam, however insurance may limit you to one per calendar year.