Does My Insurance Cover That?
Dental insurances are an excellent tool to help finance your dental treatment. However, many times the specific terms of the benefit can be very confusing for a patient to understand. Insurance policies are purchased by employers for their employees as a benefit. The employer decides upon a policy based on many factors. Depending on the employers budget, the policy will have defined benefits for the employee. Two important ones are the annual benefit amount and the percentages of coverage. The annual benefit is the amount of money the employee may use towards their dental treatment in a calendar year (usually ranges from $1000-$2500). After the employee has used up the annual benefit amount, any remaining care is at the employee's expense. Also, if any benefit remains or is not utilized within the calendar year it does not carry over to the next year. So if it isn't utilized, it's lost. The percentages of care also are determined by the policy bought by the employer. There are different categories of care defined by the insurance companies. These categories include Preventative (cleanings, x-rays, exams), Operative (fillings, extractions, root canals), Prosthodontic (crowns, bridges, partials, dentures) and Orthodontic (braces). The policy usually has different percentages assigned to each category. For example, if your policy stated it would cover 50% in the prosthodontic category, then a crown would be covered at 50%. So if the total fee for the crown was $800, then $400 would come out of the employees annual benefit amount and the remaining $400 would be at the employee's expense.
Another aspect of dental insurance coverage thats important to understand is that of in-network and out-of-network dentist participation. This means that if a dentist is in-network for a particular insurance company (Delta, Blue Cross, Aetna, Metlife, Guardian, Cigna, ect...) than that dentist agrees to accept that insurance's fee schedule for dental procedures rendered. So if a procedure is done that is covered at 100%, than there is no payment required from the patient if theres funds remaining in the annual benefit. If a dentist is out-of-network, than that dentist can determine their own fee schedule for their services. If a patient chooses to see an out-of-network provider than the insurance will still pay for a covered benefit at it's defined percentage, but it will be at the insurance's fee rate which many times is less than the usual and customary fee charged by that dental office. This translates to a co-payment required to be paid by the patient to make up for the descrepency in fees.
Other terms to be aware of are deductibles, waiting periods, missing tooth exclusions and age limitations. I know it can be a bit overwhelming and confusing trying to understand your dental insurance benefits but many times your dental office can really help. Ask for a consult or an amount of time at your initial exam to help define your benefits. It will help you plan out and manage your care more effectively as well as avoid confusion and frustration in the future. Although insurance can help lower the financial investment you make in your dental care, I always recommend choosing a dental practice based on the quality of care and professional relationship you develop with that office. In the end you'll be more satisfied and proud of the care you receive.
Belmont Dentistry is an in-network provider for Delta Dental, Blue Cross, Dentemax, Cigna, Guardian, Principal, Aetna, Assurant and MetLife. We'd also be happy to meet with you at any time to discuss your benefit and answer any questions you might have.
Give us a call today at (616) 284-3200 for a free consult!
