Questions about your insurance?
Here are the basics..
Deductible – Typically $25- $50 this is applied when you have your first dental treatment like a filling or a crown and it must be paid before you are able to use your benefits. Most insurance plans do not apply this deductible towards your preventative visits like your exams, xray’s and cleanings.
Annual Maximum Benefit – Typically $1000-$1500. Most insurance plans run on a calendar year, meaning your benefits begin and renew on the first of the year. When your insurance has paid up to this maximum amount your benefits will be cut off until the renewal date, in most cases January 1st.
Annual Maximum is Paid Out in Percentages – Most insurance plans cover services based on a percentage. Typically:
- Type 1 Services or “Preventative Service”: 100% coverage- exams, xrays, cleanings; flouride and sealants are usually covered for children up to a certain age.
- Type 2 Services or “Basic Restorative”: 80% coverage- fillings, root canals, extractions, and periodontal services.
- Type 3 Services or “Major Restorative”: 50% coverage- crowns, build ups, dentures, bridgework, dental implants.
Copayment – the amount (usually a percentage) that is due to your dental provider that the insurance will not cover.
Now for the “Exceptions.” Most dental plans have them, these are the most common:
Waiting Periods – You now have to wait 6-12 months from your effective date f or coverage on type 2 & 3 services (basic restorative & major restorative)
Missing Tooth Clause – If you are missing a tooth prior to the effective date of your insurance plan, they are not going to pay to replace it with an implant or bridgework.
Frequencies – Your insurance plan allows for certain services to be covered at certain intervals. Cleanings may only be covered every 6 months + 1 day. This means you must wait exactly 6 months + 1 day until your next cleaning or your insurance company will not pay for that cleaning.
Alternate Benefit or Downgrade Clause – Most plans will downgrade tooth colored fillings to metal or amalgam fillings on your back teeth and pay based on that contracted rate. This means that if you get a tooth colored filling on your back teeth your insurance will only pay for the cost of what a metal filling would have been. You are then responsible for paying the difference between that metal filling and the tooth colored filling. In the same manner, they also downgrade porcelain crowns to metal crowns.
What’s the difference between Indemnity, PPO & HMO Insurance Plans?
Indemnity or Traditional Insurance
Indemnity or Traditional Insurance reimburses members or dentists at the dentist’s fee schedule or UCR (Usual, Customary & Reasonable fee). This allows you to go to any dental office you choose.
(Preferred Provider Organization) is the most common form of insurance. They provide members with a list of participating dentists to choose from. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings.
Also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. You are assigned to specific dental offices that the insurance company dictates. HMOs generally don’t pay for services you receive. Fees are usually greatly reduced, but you are solely responsible for paying the doctor.
For your convenience we accept Visa, MasterCard, American Express and Discover. We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered unless other arrangements have been made in advance. Our office is also affiliated with the financing company, Care Credit, which offers 12 months of no interest financing upon approved credit.
Visit Carecredit Financing for more information.