Insurance Tips

How to Get the Most Out of Your Insurance

We would like to help you make the most out of your dental insurance coverage so we have compiled some tips that may be able to help you.

Make Sure Your Insurance Information is up to Date

Our front desk strives to give you all the benefits and coverage you are entitled to to ensure the best experience possible. By providing us with all the current information about your dental insurance we can determine the benefits we need. If your employer switches their carrier or you get a new job, let us know as soon as possible so that the front office can verify and obtain your new benefits.

Review Your Dental Insurance Coverage and Benefits Payments

Dental insurance plans differ from one to another. The easiest way to plan financially is to know your plan inside and out before you decide on any course of treatment.

In Network or Out of Network

We are out of Network. What does that mean for you in terms of coverage?

1) The annual maximum for your dental insurance is the same for both in or out of network.
2) The deductible is usually also the same, sometimes there is a slight difference. For example In Network the deductible may be $25 and Out of Network may be $50. Generally the deductible is $50 in or out of network.
3) In dentistry there are different levels of care. Insurance companies use this to their advantage by downgrading procedures so they pay for less which means more for you out of pocket. For example when you get a filling on one of your molars, most insurance plans will only cover amalgam fillings and not resin. They will downgrade the cost of the procedure to amalgam and by the time it’s all said and done, you end up paying half or even more than half out of pocket!
4) What about the in network low contract fees which sound like they can save you money? Insurance fees are structured by location or zip code. You may end up driving many miles to get your maximum coverage on an antiquated silver filling, wasting time and the cost of gas.

Annual Maximums & Deductibles

You should know how much your annual maximum is and how it is used. For example, most insurance plans cover exams, cleanings, and x-rays at 100% but that doesn’t mean it’s free. The amount of your hygiene appointment goes towards the annual maximum. Coverage at 100% only means no out of pocket for you. Say you have a $1500.00 maximum and your hygiene appointment was $142.00. The remaining balance on your maximum is $1358.00. This is very important to understand when planning for future treatment that may be needed.

Be aware of your deductible amount and for what treatments it is used for. Most insurance plans do not apply the deductible for cleaning, exams, and x-rays but some do.

Scheduled Rate of Benefits

Scheduled Rate of Benefits is the rate at which insurance plans will pay for a treatment for example: cleanings 100%, exams 100%, fillings 80%, and crowns 50%.

Frequencies and limitations

In order to get the most coverage and pay the least in out of pocket expense, it’s important to know what your insurance plan will cover and what they won’t and how many times per year they will cover the procedures.

Annual Dental Benefits Payment Schedule – Use It or Lose It!

The benefits that aren’t used this year will not roll over to next year. If you have dental work to do and you’ve met your deductible, schedule an appointment to get your treatment done before the end of the year. If you don’t use your benefits the funds will just go back into the pocket of your insurance company so don’t put off your treatments and make sure to plan your appointments ahead of time.

Spread Out Your Treatment Plan… It’s better!

Scheduling appointments throughout the year not only maximizes your insurance coverage but it makes for a better overall dental experience. Nobody wants to have back to back dental procedures. It's not only time consuming but can be uncomfortable as well.