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Dental Insurance FAQ
DO YOU 'TAKE' MY INSURANCE?
WHY AREN’T YOU A PREFERRED PROVIDER (PPO) FOR MY INSURANCE?
WHAT DOES PPO MEAN?
DOES THE DENTIST GET PAID BY THE INSURANCE COMPANY JUST FOR SIGNING UP TO BE A PPO?
I HAVE INSURANCE, SO WHY IS THERE AN OUT-OF-POCKET EXPENSE FOR MY TREATMENT?
YOU TOLD ME I OWED ONE AMOUNT, BUT NOW I HAVE A BILL FOR MORE. I THOUGHT MY INSURANCE COMPANY WAS SUPPOSED TO COVER THIS. WHAT HAPPENED?
We do our best to estimate your out-of-pocket cost before you leave our office. It’s always our goal to be as accurate as possible about what you owe for your visit. As much as we try to be experts on every person’s dental insurance, our real expertise is in dentistry! Please remember that we are a PPO for nine insurance companies and each company has dozens of plans that an employer can purchase for an employee. We encourage all patients to be advocates of their own health. But rest assured that we will do everything in our power to make sure you get the full benefit owed to you by your insurance company. Here are a few reasons why you may have received a bill:
- Your insurance plan paid a lower percentage than expected for the procedure.
- The treatment you needed was not covered by your plan.
- The insurance company decided you did not need a procedure that the doctor identified as necessary or downgraded a procedure code.
- You have not met your deductible.
- You have not reached the end of your plan’s waiting period and are ineligible for coverage.
- You’ve maxed out your plan (used up all your benefits on other procedures) and no longer have coverage until the plan resets next year.
Think about it like this. Pretend that your insurance card is like a debit card. If the procedure is covered, there’s money in the bank to pay for it. You wouldn’t spend money without knowing it’s there waiting on you in your checking account. Insurance is similar. If you know your plan, you will know whether the funds are there to pay for services.
But insurance can be really confusing. That’s where we come in. We will take the time to explain your benefits to you as best we can. It’s why we have so much information on our website. We want to educate you so that you can be empowered to take charge of your health and get the full benefit of the insurance you work hard to pay for.
HOW LONG DOES IT TAKE FOR AN INSURANCE CLAIM TO BE PAID?
THE DENTIST SAYS I NEED A CERTAIN PROCEDURE, BUT IT ISN’T COVERED BY MY INSURANCE. WHY NOT AND ISN’T THERE SOME OTHER PROCEDURE THAT WOULD WORK JUST THE SAME?
WILL YOU CHANGE THE DATE OR PUT A DIFFERENT DATE ON MY PROCEDURE SO MY INSURANCE COMPANY WILL COVER IT?
WHAT IF I STILL HAVE QUESTIONS?
I WANT TO TAKE CHARGE OF MY HEALTH. WHAT QUESTIONS SHOULD I ASK MY INSURANCE COMPANY/PLAN ADMINISTRATOR?
Your insurance company can provide you with a breakdown of your dental benefits, but there are six key things to ask about:
- Plan Year: Does your insurance follow a normal calendar year? (Jan. 1- Dec. 31) If not, what month and day does your plan year start and end?
- Yearly Maximum: What is your annual maximum benefit dollar amount?
- Waiting Periods/Age Limitations: Are there any waiting periods for benefits to begin or age limitations?
- Frequencies: How often does your plan cover cleanings, exams, x-rays, fluoride, and sealants?
- Composite Restorations: Does your plan reduce coverage to the rate of old-fashioned amalgam restoration material or does it cover up-to-date composite fillings?
- Percent Coverage: What percent does your insurance cover for:
- Basic Restorative?
- Major Restorative Treatment and Prosthodontics?
Once you have this information, bring it to us! It will help us understand your plan as well and help us better estimate your out-of-pocket expense.