Insurance can be a very difficult thing to understand! Trust me, we deal with it daily. There are many different companies out there that cover (or don’t cover) the treatment you may need at the dentist.
When you show up for your first appointment to the dentist it is best to have your insurance information handy. If you have been sent a card, have it available for the front desk so they have all of the numbers to quickly check what your plan covers, otherwise you may be waiting for sometime in the waiting room instead of getting those teeth shining.
Every insurance plan has a different “breakdown” of benefits. A breakdown is what percentage your insurance covers for each service. Sometimes the percentage can be misleading. Insurance companies have a network and each dentist decides whether they would like to be in network with that insurance company or not. If a dentist is in network with an insurance company they sign an agreement to accept the fees the insurance company pays and the patient essentially gets a break on the dentist fee, and saves money by going to the dentist that is in network with their insurance. If you decide to go to a dentist that is out of network, the insurance will only pay the dentist their contracted fees and the patient will have to pay the dentist’s fees. For example, if you go to an out of network dentist and your insurance says they pay 100% of a cleaning this could be what the breakdown looks like:
Dentist fee for cleaning: $100
Insurance pays: $80 (insurance maximum fee for cleaning to dentist)
Patient pays: $20 for cleaning
Even though the insurance says it pays 100% of your cleaning, the insurance only means they pay 100% of their fees to your cleaning.
In the world of dental insurance you only have one deductible per year. The insurance will take this out of your first visit to the dentist each year, you will usually have to pay this at your first visit for the current year. Some insurance companies only charge the deductible if you have fillings or other restorative work done.
All insurance companies also have an annual maximum benefit. It can range from $500 to $2,500 they will cover per year. Any treatment that goes above that amount is also the patient’s responsibility.
With a little investigation into your dental insurance plan you can save yourself a lot of money in a year! As always, if you have any questions feel free to contact your dentist or insurance company.