Learn About Maximizing Your Dental Benefits

maximize dental benefits

September is here! Only three more months until the end of the year and for your dental benefits to reset. Don’t let your dental benefits go to waste, use them while you still have them for this year. Dental insurance is not like medical insurance, they pay for partial coverage, and if you’re not using your annual maximum, you run the risk of losing it for next year. If you have dental insurance, use the benefits you’re paying for to get the dental treatment you need now to maintain a healthy, beautiful smile. Learn about seven ways to maximize your dental benefits.

Review Your Policy

Ask your insurance carrier or employer for more information on your dental plan. With more information at hand, you’ll be to understand and determine what your plan covers and what it doesn’t. It helps you to be informed of the procedures your insurance will pay and which you’ll have to pay out-of-pocket. The more information you have on your plan and the better you understand how it works then, you can be financially prepared for the specific dental treatments you need to be covered.

Consider Visiting a Preferred Dentist

As you well know, not all dentist are participating providers with insurances, so we recommend finding a dentist you can trust with your dental care and that’ll take your insurance. One of the ways you can find a dentist is by choosing a preferred provider. What does that mean? It means a dentist who’s contracted and accepts your insurance company fees within your insurance. A preferred dentist can help you save money and time since you won’t find yourself paying more out-of-pocket.   

Ensure Information is Updated and Recorded

Insurance company systems aren’t updated immediately which can lead to coverage gaps due to the untimely processing and system updates. You want to ensure you keep all records of treatment and payments for you and your family to avoid the unnecessary prolonged dental treatment. Being active on your part can help ensure there are fewer delays and problems in proceeding with your treatment.

Use Your Benefits Early

Consider using your benefits early in the year since some insurance companies have limitations on when you’re allowed to visit the dentist such as dental cleanings and exams. Plan to use your dental insurance to make the most of your dental insurance and to save money. Don’t lose out on your benefits, visit your dentist for treatment early on before the end of the year holidays. Towards the end of the year, the dental office gets busy that you run the chance of missing out on completing treatment which results into paying more money next year.

Annual Dental Check-ups

Most dental insurance has coverage for annual dental visits, visits you and your family should be taking advantage of every year. Part of maintaining a healthy smile is visiting the dentist yearly to get a check-up. Sure, you may practice good oral hygiene, but a dentist knows your mouth and teeth better than you. They can spot if you have any dental conditions which need some attending or if there’s a severe problem going on. If your insurance covers dental check-ups, then don’t miss out on dental coverage for you and your family.

Split Treatment

If you’re in need of significant treatment and it’s the end of the year, break your treatment between this year and the new year. Splitting your treatment time will help reduce the amount of money you spend and enable you to maximize your benefits this year and next year. Discuss your treatment options with your dentist and treatment coordinator to find the best financial alternatives you have, use the services your dental office offers.

Don’t Wait Until Last Minute

As we mentioned before, dental benefits expire and reset. Use them throughout the year to get the most out of them and to ensure your annual maximum isn’t cut back. Each insurance policy has their restrictions on how many times you can visit the dentist and what treatments are covered; therefore, we cannot stress enough why you use your benefits as early as possible.

Familiarize yourself with your dental insurance to make the most of your dental experience and treatment. When you’re informed about the coverage and the expenses you will need to pay, it can help them move along the process for treatment and finding other financial alternatives to continue treatment you need. If you want to schedule an appointment at our offices, please fill out this form.

Dental Insurance Denied Claim? What to Do and Know

Dental Claims Denied

Have you gotten a dental treatment done that your insurance has denied covering? Don’t worry; we are here to help. Keep in mind dental practices don’t work for insurance nor are they obliged to send appeals on behalf of patients. Most dental practices offer assistance in sending appeals as a service so if they do, use their services to get your dental claim appealed and processed soon.  

Become familiarized with your policy and coverage will be advantageous everytime you go to your dentist for a routine check-up or treatment procedures. It will help you avoid dental claims being denied and any worry you might have of how your dental benefits work. Below you will find three ways which can help prevent claims being rejected.

Review Information

We highly recommend you review your information at least every year with your employer or insurance company for your records and our own. You always want to verify with your employer or insurance company your information such as group and coverage number and to avoid delays in processes and to get dental claims denied. Most common reasons they deny claims are incomplete and inaccurate claims. When you are filling out a dental claim provide all the information it requires.

Legible Documentations

Legibility is a must! When filling a claim ensure your handwriting is legible to understand. This can include other documentation you might have to provide to process the application. The most common documentation that needs clarification is x-rays and charts! X-rays and charts are difficult to read which is why if these documents are required ensure you send in a form narrating the reason for treatment. Sending documents without a clear interpretation or narration that explains why you need dental treatment.

Beware of Limitations

We always say this, and we mean it for emphasis, review and understand your policies. Always ask for a copy of your plan, dental contract, and a list what your insurance covers. Having all these documentations with you can help you better understand how much the insurance will pay and how much you will have to pay out-of-pocket. Dental policies have many restrictions based on age and frequency.

Age limit restriction can prevent you from getting a dental procedure because of your age often being younger. Frequency limitations usually restrict the number of dental services you’re allowed to exercise in a year. For example, you can have restrictions on how many times you can have cleanings and x-rays. Knowing the specifics of your policy to see what is included and excluded will help you understand what will be denied by your insurance.

Even if you have looked over your dental contracts and coverage and still get a dental treatment denied, we are here to assist you! We will help you with the proper documentation your claim needs and send appeals on your behalf. Our account managers are here to answer questions and concerns you might have. Don’t hesitate to ask our managers.

If you don’t understand why your claim got denied call your insurance to inquire about the reason(s) your claim got rejected and what you might need to get the application processed. Remember the more you’re aware of your insurance, what it covers for your and the eligibility for your family, the smoother the process of getting the dental treatment you need will be.

If you need some assists with appealing a denied claim or require medical documentation along with a narration of why we are more than happy to provide you with the information you need. Please don’t hesitate to call our account managers at 801-505-7125.   

What to Know About Your End of the Year Dental Benefits

End of the Year Dental Benefits

We’re in the middle of the year! It’s fascinating to see how quickly time comes by when we’re in other seasons and how it elongate itself towards the summer. But as you know, once summer is over the end of the year comes quickly along with the festive holidays, giving us little time to think about minor details.

This year we decided to let you know ahead of time to think about your dental insurance, which is dental benefits. Every year your benefits expire and reset so take advantage of them now before the end of the year. Did you know there is an average of 2.5% of people who reach and exceed their annual maximum for their plans? Be part of the percentage who uses what is paid for whether by you or your employer.

I like to think of dental insurances as a cycle of benefits; they repeat themselves yearly. Below find a cycle graph of the five reasons why you should be using your dental benefits now.  

Get a jump start in continuing to use your benefits before the year ends. If you need to see a dentist, contact The Center of Dental Professionals by filling out this form here.   

End of Year Dental Benefits

Your Dental Insurance Explained

Dental Insurance Explained

Dental insurance should cover my dental expenses, right? Think again. Dental insurance is not insurance but benefits. They are not like medical insurances; they are benefits that include some dental expenses, not all expenses. Of course, the amount of coverage you have for the dental services is dependent on the plan you have or that your company has chosen for you.

Verify your policy and insurance first before you call your dentist to ask why you keep receiving a bill denying your dental services or treatment. Below you can find some information as to why your dental insurance is rejecting some of your dental expenses.  

Dental Insurance Explained

5 Things to Know About Dental Insurance

What to Know Dental Insurance

Do you have dental insurance? If yes, how well do you understand your dental insurance policy? Most often than not, patients who have dental insurance have a hard time understanding their dental insurance policy. There are many dental insurance plans and policies to choose from or that you have but may not be familiar with.

So, what do you need to know about dental insurance? We have listed 5 things you need to know about dental insurances when it comes to using it in dental clinics.

#1: Dental insurance is not like medical insurance.

What do we mean? Your dental insurance isn’t insurance but benefits. Dental insurance is not intended to pay a significant portion of your dental expenses but be an aid. Dental insurance provided by an employer usually covers a part of the cost of dental services.

#2: They are typically described as “100-80-50” coverage.

Dental insurances can say they cover 100%, but that is dependent on how much your employer paid for the plan. The less they spend, the less you receive in benefits. Usually, 100% of the coverage goes to preventative and diagnostic care, 80% to 70% on basic procedures and 50% or less on significant treatments. Again this is dependent on the plan an employer has purchased for their employers.

#3: You receive what your employer pays.

If your employer pays less for dental insurance that is what you will get, what they put in. The less the insurance funds, the more you will need to pay for your dental expenses. The fees dental clinics charge are the same for each patient regardless of the dental insurance you have. So, if you have to pay more, look carefully at how much your dental insurance is covering. Also note, most dental insurances will not cover all preventative care which is why getting your dental benefits explained is essential to know what is being included.

#4: Insurance encourages you to use providers within their network.

Often you will find that insurances have a list of “preferred providers”. What it means is, you will be given a list of providers who have agreed to reduce their fees to what insurances want. In these cases, the dentist on this list has agreed to add restrictions which have been placed by entering into a networking plan of “preferred provider”. When restrictions and reduced fees are agreed upon so are the quality of the work and materials used since most practices will have to keep costs low to meet the agreement between the insurance.

#5: Dentists don’t work for dental insurance companies.

Why is this important to know? Because some patients expect dentists to submit claims for them and figure out insurance issues they may be having trouble with. Yes, although some dental practices offer to send claims to insurances, it does not mean they work for insurance companies. They are just adding value to their patients by helping them submit applications with the necessary documentation. If you receive a notification from the insurance company saying they have not received the documents needed, verify with your dentist with when they submitted the claim and call your insurance before getting mad, again keep in mind dentist, and dental staff does not work of the insurance company.

We recommend before you start using your dental insurance, you get a copy of your dental policy to become more aware of what is being covered and at what percentage it is willing to cover. Remember dental insurance is not insurance, it is dental benefits which help you cover partial expenses of your dental treatment and preventative care. If you have questions of what’s included, we encourage you to ask your insurance company or employer and if you want to know if your dentist will take your insurance to ask them.

Your Dental Insurance Benefits Explained

You have dental insurance, and it should cover your dental procedures, right? Think again. It’s a misconception people, in general, have of dental insurance. Dental insurance benefits, a frequent misunderstanding that can be frustrating for both a dental office and those insured.

So why isn’t it covering your all of the dental procedures you need?

Before we can answer that we need to clarify that medical insurance is very different from dental insurance. Most insurances often referred to it as “dental benefits” than coverage. Typically, included in your dental benefits often depends on the plan you’re in, and usually, it’s only meant to cover part of your expenses.

So when you receive a bill for denied services, or a treatment plan with procedures not covered, here is some information as to why.

Dental insurances are typically described as a “100-80-50” coverage. What does that mean? It means 100% coverage is towards preventive and diagnostic care such as check-ups and cleanings. 80%, although sometimes 70% to 80%, coverage is towards basic procedures such as fillings and 50%, or less, coverage is towards major procedures like crowns, root canals, and bridges.

Dental insurance only covers up to a specific annual limit typically between $1000 – $1500 annually. Every year you are given a yearly limit by your insurance company of what the insurance will cover up to for your dental needs. As you can see, it’s an insufficient number for the year, and you can quickly exceed it if you have extensive treatment to be done. In addition to the percentages of what is covered by your dental insurance, this limited annual coverage is quickly used, leaving you responsible for 100% of the remaining treatment.

There are three variations of dental insurance that have limitations on coverage and where you can go. The HMO, health maintenance organization, which restricts coverage to dental professionals within their limited network. PPO, preferred provider organization, policies charges reduced rates within their network of dentists, which provides you with contracted fees from your dentist. Some PPO’s allow you to see a Dentist outside your network and pay less towards those services.  Indemnity plan, the last of the three, will enable patients to look at any dentists and typically picks up a percentage of the costs.

Dental insurances typically do not cover pre-existing conditions. If you already had an existing dental problem and are hoping your insurance will cover it, think again. Pre-existing conditions are not covered by insurance which means you’ll have to pay for the treatment you need out-of-pocket. An example is a missing tooth that you had before your current dental coverage, most likely, having it replaced with an Implant would not be covered, it would fall under pre-existing.

They have limitations and exclusions to their plans. Some insurances will place restrictions on what they will cover. Not ideal, I know, but they do anyway. These limitations can include how many times you come in for particular procedures. Then there are the exclusions which refer to the dental procedures not covered by dental insurances.

When you take into consideration the annual limit you have, along with restrictions that apply, chances are your dental insurance isn’t going to be paying for all your dental needs. You will. But that doesn’t mean you should avoid getting the dental treatment you need. Besides having your insurance cover a percentage of your dental procedures, you could look into getting a dental discount plan. A dental discount plan can help reduce the cost of procedures and enable you to maintain a healthy smile.

If you have any questions regarding your insurance benefits, please feel free to call us today at 801-747-8018.