You pay for it every month, but most patients are not sure exactly how their dental insurance plans work. As a result, many patients can overpay for treatment, delay needed treatment or even avoid having covered treatment performed because they aren’t sure their dental insurance will cover the cost.
If you understand your plan, and how it works, you will be far less likely to end up with claim denials and unexpected dental bills.
Understand Your Plan
Dental insurance is a tool to help patients with the costs involved in maintaining good dental health. It is important to understand the provisions and limitations of your individual dental plan. Reading through the plan documents can be boring and time consuming, but you should definitely do it before using your plan benefits. It is the responsibility of the patient, not the insurance company or the dentist office to pay for services rendered. If you understand your plan and how it works, you will be far less likely to end up with claim denials and unexpected dental bills.
Most PPO (Preferred Provider Organizations) plans have provisions for fee reductions when a patient has services rendered by a participating network provider. The participating providers have agreed to an itemized fee schedule which provides for fee reductions of the total price of treatment even BEFORE any insurance plan payments are made.
Most covered services have fee reductions from 10-35% off the regular fee when you stay “in-network”.
Read Your EOB
An Explanation of Benefits statement is provided to both the dentist and the patient every time a claim is paid or denied. Make sure to read it, understand it and compare it to your itemized receipt for services provided by the dentist. Make sure the plan has paid your claim correctly. If any charges were unpaid or denied, find out why. Don’t pay for services not paid by your insurance without first calling the insurance company and finding out why the payment was denied and what you can do, if anything to get it paid.
Know the Limits
Almost all insurance companies have an annual maximum. An annual maximum is the total maximum amount your policy will pay per year. Know what your limit is. If you have had other dental work done in a calendar year, contact your insurance company to find out how much is still payable on your behalf BEFORE you have extensive treatment. If a claim is filed by your dentist and not paid because you have reached your annual maximum, you will be responsible for the payment of the difference. Do not try to beat the system by having extensive work done in multiple offices at the same time. Your insurance company is very good at not over-paying on an annual maximum.
In addition to an annual maximum, most insurance companies limit the number of office visits, dental cleanings and x-rays which are covered annually. Visits to specialists are usually billed differently than visits to your regular dentist. Visits to specialists are also covered differently than visits to your regular dentist. Know and understand how your plan manages these limitations.
Plan Multi-Stage Treatment Accordingly
If you know that you are planning extensive treatment, you can plan the stages of the treatment to maximize your insurance plan payments. If possible, plan the stages in such a way that your annual maximum renews itself in between stages. This will allow for insurance payment of your second stage of treatment. In addition, your unused annual maximum does not carry over. If you need dental work performed and you have not used all of your benefit for the year, try to do it before it expires. This will give you a fresh annual maximum when the policy year renews itself, leaving available funds for payment of other needed dental work.
Take advantage of remaining 2017 dental benefits before they expire. Annual benefits do not "roll-over" into the new year.
Don't Miss Your Regular Appointments!
The least expensive way to maintain good oral health is to go to your dentist at least twice a year for an exam and cleaning. These services are usually covered 100% by your PPO plan. When you do this routinely, you will find that problems are detected early and require less costly treatment to repair. The best way to spend less on extensive dental work is to not need extensive dental work. Always practice good personal oral hygiene and follow your dentist’s instructions for maintaining oral health, reversing gum disease and cavity prevention.
We are a Preferred Provider
Dr. Babaloui is a preferred provider for numerous dental insurance plans. Contact us to verify that she is "In-Network" with your insurance plan. Now is the time to take advantage of 2017 dental benefits before they expire.