Most dental insurance plans don’t let insurance benefits roll over into the next year if they go unused. If you haven’t yet taken advantage of all your dental benefits, then now is the time to do so!
Dental insurance is a great way to help manage the cost of dental care and typically covered preventative services so there is little to no cost to the patient. However, dental insurance can be confusing to navigate. Understanding how your dental insurance works is key to maximizing your benefits and keeping your cost down.
At Dentistry of Old Town Scottsdale, we accept all major PPO dental plans. These include, but are not limited to Delta Dental, Cigna, Humana, MetLife, Aetna, Ameritas, Blue Cross Blue Shield, Guardian, and United Healthcare. Our staff is available to call and check on your insurance eligibility and benefits for you. Dallas is our insurance coordinator and has been working with patients in our office on their insurance for many years. We like to think of her as our dental insurance concierge.
Most dental insurance companies work in 2 waves. First, the overall cost is reduced for each procedure depending on the assigned fee schedule associated with the particular insurance company and plan. The fee schedule dictates the amount that we charge for each service and is a standard rate for all providers contacted to a particular insurance company.
Secondly, insurance reimburses specific percentages depending on 3 classifications of treatments; Preventative and Diagnostic, Basic, and Major. Most insurances reimburse 100% of the cost for preventative and diagnostic services. Typically, reimbursements are paid to the dental office. These include x-rays, exams, and prophylactic cleanings. Reimbursements are paid directly to the dental office when the office is in network with your insurance provider.
When these services are covered at 100% the patient does not incur any cost for the service rendered. Insurance applies frequency and age limitations to certain preventative and diagnostic services that may limit coverage. If this is the case, these services will still be billed at a lower fee than a cash paying patient but there will be no reimbursement from insurance.
Fillings and crowns are classified as restorative services and are usually designated basic and major, respectively. Basic restoration services are typically reimbursed at 80 – 90% whereas major restorative is usually covered at 50 – 60%. Remaining services include, endodontics, periodontics, orthodontics, oral surgery, prosthodontics, and implants. These are categorized as either basic or major depending on your insurance plan. In some cases, specific services have no coverage and do not fall in either basic or major category. If you are wondering what your specific plan considers basic or major, let us do the research for you and explain exactly what your plan covers.
Additionally, most insurances apply a deductible to all services outside of the diagnostic and preventative classification. The patient is then responsible for the amount of the deductible before the insurance will begin reimbursement.
In the case of periodontal disease, the routine cleanings are classified as periodontal maintenance. In most cases insurance considers periodontal treatment as a basic or major service. This means that insurance will only reimburse a portion of the cleaning and deductible will apply. This is why sometimes, “cleanings” are not covered at 100%.
Insurance companies also limit the amount they will reimburse a year. This is known as your maximum and usually ranges from $1000 to $3000. Most plans expire December 31st and reset January 1st of the follow year. However, some plans have alternate dates depending on the plan specifics. Once a plan has reached the max, the fee schedule will still apply, saving you money on overhead cost but no further amount will be reimbursed.
As we approach the final quarter of the year, it is important for patients to utilize their benefits before they expire. Depending on the specific insurance plan, cleanings, exams, and even x-rays may be covered free of charge if used before the benefit time period expires. Additionally, the deductible will reset as well and apply to any treatments that are rendered after the plan resets.
Every year patients miss out on free services covered by their insurance companies and don’t fully utilize their benefits. It is important to not only understand the restrictions and limitations in your dental plan but also to understand the benefits of using dental insurance. The insurance experts at Dentistry of Old Town Scottsdale can help you maximize your coverage while ultimately helping you to achieve a healthier smile.
We Can’t Wait To See You!
We’re always looking out for our patients and want to make sure you’re taking the fullest advantage of your benefits! If you have any questions regarding dental insurance, stop by or call us today and we can help!
The greatest benefits are to your dental health!
The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.