Your Insurance Questions—ANSWERED!

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No, this isn’t a magical, solve-all-your-problems blog about insurance, but hopefully it can clear up some common misconceptions about insurances and their coverage in our office!

Dental insurance can be confusing and overwhelming. There are so many options when it comes to selecting your dental insurance plan. Some of us purchase our dental policies through our employer, hunt for a plan on the marketplace or find a self-funded policy. These can be tricky waters to tread because insurance can seem like a foreign language if you are unfamiliar with the jargon.

To maximize your benefit package be sure to ask your dental insurance company about network providers or your dental office about their accepted in-network plans. This could help you narrow down which companies to shop for, especially if you love your current dental office. But just because a company is not in-network with your office does not automatically mean you won’t have coverage there. Let’s do a little math problem as an example.

EX: Your family has Ameritas dental insurance that covers preventive services at 100% and your dental office is NOT in-network. Ameritas representatives would be able to tell you exactly how much they will pay for each dental procedure. Suppose they will pay $50 towards a procedure that your dental office charges $55 for. You would be responsible for the $5 difference.

EX: Your family has Ameritas dental insurance that covers preventive services at 100% and your dental office IS in-network. Being in-network means the dental office will match fees with your insurance company. So say your dental office completes the $55 procedure and sends it to Ameritas. If Ameritas only pays up to $45 for the procedure, then your dental office will discount the $10 difference and you would owe nothing.

Marketplace plans are fairly new and fairly confusing. Many times the insurance will claim that you have pediatric dental benefits embedded in your plan. While true, this is slightly misleading. The majority of these plans require you to meet your medicaldeductible before they pay anything toward a dental visit. Submitting your dental claims to the medical insurance will help you meet the deductible, but some deductibles are so high that coverage for dental services simply does not happen. However, processing these claims can gain you the preferred provider (PPO) network discount toward your services.

Dental offices perform services based on the recommendations of the American Dental Association. Your insurance plan may exclude some services for payment based on their frequency limitations. Your insurance company provides this information in a plan booklet or possibly online. For example, if your insurance covers fluoride one time per year even though your dentist recommends it every 6 months.

Finally, it is important to read any information you receive regarding your insurance and provide your dental office with the most current dental card(s).  Not sure what everything means?  Bring it into your dental office for them to help decipher!  We are happy to answer any questions you may have about percentages, deductibles, maximums, and frequencies.

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