How is dental insurance different from medical insurance?
First, dental insurance is very different from medical insurance. While medical insurance might seem pretty straightforward, you visit your provider, pay your deductible, and if there's any remaining balance, you receive a statement in the mail. Dental insurance works a little differently. It will provide a basic coverage breakdown, but there are many limitations and clauses that can determine your eligibility for a service, even if that service is a covered service on the plan.
How are dental services typically categorized by insurance?
Dental insurance will usually divide services into three categories. The first category is preventive, which includes services like exams, X-rays, and cleanings, and preventive services are often covered at 100%. The second category would be basic, which includes services like root canals, fillings, and sometimes extractions, and these are often covered at 80%. The last category is major, which includes services like crowns, dentures, and implants, and major services are usually covered at 50%. However, these percentages can vary depending on your individual plan.
Does having two dental insurance plans mean everything will be covered?
A common misconception is that if you have two dental insurance plans or dual coverage, you won't have a copay and everything will be covered. Unfortunately, that's not always the case. Dental insurance plans coordinate benefits differently.
If the secondary plan has standard coordination of benefits, the secondary insurance may help cover what the primary insurance did not pay. However, if the secondary plan has no dual or non-duplication coordination of benefits, the secondary insurance may not pay anything until the primary benefits have been exhausted for the year, or if the primary insurance already paid more than the secondary would have if it were the primary plan.
This can leave you responsible for a portion of the cost, such as 20% for basic services or 50% for major services, along with any applicable deductible.
Are pre-authorizations a guarantee of payment?
Another misconception is that pre-authorizations are a guarantee of payment. Pre-authorizations are not a guarantee of payment because the final payment depends on your benefits and how the claim is processed after the treatment is completed.
What should I know about orthodontic benefits?
Dental insurance plans commonly provide orthodontic benefits as well, but there are some limitations. Most of the time, coverage is only applicable to dependents up to a certain age. There's also usually a separate lifetime maximum for orthodontic procedures. This means that once the orthodontic benefit has been exhausted, it does not renew the following year.
Can treatment cost estimates change after insurance processes the claim?
When it comes to treatment costs and estimates, dental offices will always do their best to provide you with an accurate quote. However, this amount can change once the insurance company processes the actual claim. Dental insurance plans can withhold coverage because of limitations and clauses listed in the plan. These can include age limits, missing tooth clauses, waiting periods, frequency limitations, and remaining annual maximums. Ultimately, the insurance company determines the final payment and your portion.
What should I do when signing up for dental insurance?
When signing up for dental insurance, make sure you read the fine print and fully understand the limitations and clauses of your plan. This can help you determine what coverage you actually have and avoid unexpected costs.
If you’re searching for quality dental care, we’re here to help. Call (253) 544-4073 or email [email protected] to schedule your visit. Our team is committed to keeping your smile healthy.