Happy Insurance Awareness Day! This day was created for people to view their insurance coverage! Have you ever wondered how dental insurance works or had any questions? Here’s some explanation of dental insurance!
Dental insurance is a type of insurance that helps individuals pay for their dental care. While the specifics features of dental insurance plans differ, typically they will include coverage for preventive care like routine exams, x-rays and cleaning. Most plans will also include coverage for dental services like fillings, extractions, root canals, crowns, and in some cases orthodontics. The plan you choose will dictate how much you will pay, how much the insurance company will pay and it might even dictate which dentist you need to visit. It’s important that you understand your coverage so that you can take advantage of your benefits and understand what you are responsible for!
How Does Dental Insurance Work?
Finding a dentist is just one piece of the puzzle, once you have one, you’ll likely want to know what you will have to pay when you go to the dentist. That will depend on the specifics of the plan. Most plans use a “benefit year,” to determine when the benefits are available for use. Your dental office will typically verify your dental insurance for an estimate of how much you will be expected to pay. After a visit to the dentist, a request for payment will be sent to your insurance company; this is called a claim. The insurance company will review and process the claim and then explain how the claim was paid with an EOB, or explanation of benefits.
Ultimately, your financial obligation is based on the treatment you receive and the specifics of your plan some of which might include the following:
- Deductibles – an amount you must pay before the insurance company will pay anything.
- Coinsurance – once the deductible is met, you may have to pay a percentage of the cost of covered treatment, for example you may have to pay 50% of a major procedure.
- Co-pay – a fixed cost for a certain procedure
- Annual Maximum – the maximum amount the insurance company will pay during the benefit year. Once that maximum is reached during a benefit year, you pay all additional expenses.
- Exclusions – services and/or products that insurance won’t cover
- Waiting period – some plans won’t cover certain procedures until a certain amount of time has passed. These are usually major procedures and sometimes basic.
- Limits – many plans have time limits for certain procedures. For example, many plans will cover two cleanings a year, as long as six months has passed between them. Limits may also apply to the frequency of x-rays and to treatments on a specific tooth.
- Pre-existing conditions – some plans won’t cover conditions that you had before signing up for their plan, meaning you will be responsible for paying for treatment for that condition.
Understanding your dental insurance is a part of feeling comfortable going to the dentist. Knowing how dental insurance works will ultimately help you to make better choices about your dental care so that you can achieve a healthy and happy smile! Here at First Impressions Family Dentistry we will do a complimentary insurance breakdown anytime to help you achieve that goal while maximizing the benefits of your dental insurance Have questions about your dental insurance and the benefits of a dental plan? Just ask! Text or Call us today! 704-933-2115