There are thousands of dental insurance plans offered either personally or through your work. We are not insurance agents but with years of experience in working with dental insurance companies, we try our best to address the concerns and questions of our patients. We wanted to provide you with answers to some of our most common questions. As always, it is best to consult with your insurance agency for exact answers. As a courtesy to our patients, we do our best to help them navigate their plans and receive the most benefit from them.
1. Do you take our plan, or are you in-network? We are considered an “out-of-network” provider with all insurance plans; however, we file claims for all our patients. Most insurance plans have an out-of-network benefit. Majority of patients do not see a difference; however, there are some plans that have a fee schedule that is lower than usual and customary to the area. Our fees are set as usual and customary to the area, so if your insurance plan has a fee guide that is lower than ours, you will see the difference in price. We remain out-of-network so that we can continue to provide world-class care to all of our patients and not be dictated by insurance providers.
2. Why is there a yearly maximum on my plan? Every dental plan has a “yearly maximum”. The most common maximums are $1,000 or $1,500 but some plans have lower or higher maximums. This means that your dental plan will provide a reimbursement of your services up to the yearly maximum. Once they have paid that amount for the benefit period, then everything is out of pocket. This is the opposite of health insurance policies, as health insurance usually covers 100% once you have reached your deductible. We typically say that dental insurance is merely a “reimbursement plan” and not true insurance. Did you know that most insurance yearly maximums have not increased since the 1970s?
3. Do the yearly maximums apply to myself or family? Each member on the policy has their separate yearly maximums.
4. Do you take Medicare or Medicaid? Medicare alone does not have a dental benefit. You have to apply for a supplemental policy for any dental reimbursement. Even with the supplemental policies, you will not receive 100% coverage but will get some reimbursement on services. We do not take Medicaid at this time. Most county clinics are Medicaid providers, so make sure to check with your local county clinic if you need Medicaid services.
When you are evaluating a dental plan make sure to read the fine lines! Especially when it comes to waiting periods, missing tooth clauses, and if you have out-of-network coverage. More and more offices are electing to be out-of-network, and you will want to make sure you have out-of-network coverage, or at least know where your closest in-network provider is.
We hope this helps provide some clarification on the world of dental insurance. If you have any questions specific to your policy contact your insurance provider, or your plan’s customer service. We will always help you in trying to maximize your dental benefit.
