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.