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- Veneers and caps
- Implants - Crowns
- Oral surgery
- Bridges - Dentures
- Tooth contouring and reshaping
- Gum surgery
- Dental sealants
What are the various types of dental insurance coverage?
According to most dental insurance companies, dental procedures are broken down into three categories:
Preventative - Most insurance companies consider routine cleanings and examinations as preventative dental care, however, X-rays, sealants and fluoride can be deemed as preventative or basic, depending upon the specific insurance carrier.
Basic or Restorative - Basic or restorative dental treatment usually consists of fillings and simple extractions. Root Canals can be considered basic or major. However, the majority of dental plans list root canals as basic.
Major - Crowns, bridges, dentures, partials, surgical extractions and dental implants are dental procedures that most dental insurance companies consider as a major procedure.
Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category.
This is important because some insurance plans don't cover major procedures and others have waiting periods for certain procedures. If you know that you will need major dental work that is not covered by a given plan, you should probably look elsewhere to find one that suits all of your needs.
Should I purchase dental insurance?
With the rising cost of going to the dentist, many people are struggling with the decision of whether or not to purchase dental insurance. Whether you are considering buying dental insurance through your employer or independently, be sure to investigate several different plans and ask questions about the factors listed below. This information will help you choose the right dental insurance plan before signing on the dotted line.
What is meant by my insurance yearly maximum?
The yearly maximum is the most money that the dental insurance plan will pay within one full year. The yearly maximum will automatically renew every year.
What if my dental insurance plane does is not accepted by your office?
Most independent dental insurance plans will only pay for your dental services if you go to a contracted and participating In-Network Dentist. Find out if you are required to go to a participating dentist or if you can choose your own. There are some dental insurance plans that we have chosen not to participate in.
If you wish to continue to be treated in our office, some policies allow you to see an Out-of-Network Dentist, however, the costs covered may be significantly lower.
What does “usual customary and reasonable” mean?
Almost all dental insurance companies use what is called a Usual, Customary and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning but your insurance company will only allow $58 because that is the UCR fee that they have set.
If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.
How do I know if my insurance requires a designated waiting period before they will cover a procedure?
A waiting period is the length of time an insurance company will make you wait after you are covered before they will pay for certain procedures. For instance, if you need a crown and the policy has a 12 month or longer waiting period, chances are you could have already paid for your crown while you have been paying your premiums and waiting.
Can you explain my policies “Missing Tooth Clause and Replacement Period”?
More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
What exactly is direct reimbursement?
When it comes time to purchase dental insurance, you may wonder what options are available. There are basically two types of dental insurance plans: direct reimbursement and traditional dental plans.
A direct reimbursement plan is a dental insurance plan that is usually entirely funded by your employer and allows you to choose any dentis without the hassle of networks. With a direct reimbursement plan, you are reimbursed for money spent on dental work, which is not limited to specific treatments. Some employers may choose to reimburse you after you have paid for your dental work, and some may choose to pay the dentist directly -- leaving you with less out-of-pocket expense.
You can choose any dentist.
As with a traditional dental insurance plan, a direct reimbursement dental insurance plan usually has a maximum yearly allowance. This means that the plan will only pay for a certain amount of dental work each year. The average yearly allowance for any type of dental plan is around $1,000 to 1,500.
A common direct reimbursement plan would pay for 100% of the first $100 spent on dental services; 80% of the next $500; and 50% of the next $1,000.
Choosing a dental insurance plan is an important decision and understanding the different types of dental insurance plans available will make this process easier