Understanding how much your dental insurance will help you better prepare for any outside payments to cover your treatments. However, today’s dental market filled with various options can make understanding your plan difficult. As dental practices often have to adapt to processing payments and insurance requests, our medical market presents many challenges for people needing dental treatments, including crowns, dentures, wisdom teeth extractions, and implants. As dentists, we’re not only responsible for caring for patients’ teeth, but also helping patients understand their insurance and how practices process requests to help them receive treatment.
The Basics of Your Dental Insurance Broken Down
When compared to medical insurance, most dental insurance offered in the market is provided by private companies. Government-funded health insurance, including Medicaid and Medicare, often provide dental insurance, but even these insurance plans can vary depending on which one you apply for. Within these options, numerous plans are provided, offering coverage for various medical, dental, and vision services. For many dental practices, each practice will have its own selection of dental plans they accept as it is easier for these practices to work within the network. Working with practices that accept your insurance plan will ultimately reduce costs associated with your treatments, as working outside of your plan’s accepted practices can cause more expenses.
While many dental plans will vary in what treatments they cover, there are ultimately three types of insurance plans that patients can choose from, including:
- Preventative: Preventative dental plans work to cover annual visits, semi-annual visits, and cover procedures that are preventative, including fluoride treatments, cleanings, and dental sealants.
- Basic: Basic coverage includes more treatments than preventative, including extractions, fillings, gum disease treatments, and root canals. Often, these plans will also include information about co-pays, deductibles, and co-insurance payments for overall expenses.
- Major: Major dental coverage includes all of the above plus restorative treatments, including crowns, implants, bridges, and inlays. However, many of these plans usually cover costs at 50% and will require out-of-pocket expenses.
Although these are considered the basics, many dental plans can vary on what they will cover and how much they will cover. Depending on the specific plan, certain treatments can be covered at a certain percentage of the overall costs, and leave the rest of the percentage to the patient to cover the rest of the procedure. It’s important to learn about how your coverage applies to your treatments, as practices often have to submit requests to your insurance company and go through the waiting period for approval.
As each practice have their own methods of approaching dental insurance, your insurance company will have to assess the costs and risks associated with your treatments. Preventative treatments, for instance, will provide the most security for insurance companies due to the research and success rates behind them. Other factors, including your age, current health, and impending risks to your dental health are also taken into consideration by your insurance company during the waiting period.
What To Look For From A Dental Practice
Today’s dental industry requires practices to make continuous efforts towards helping patients receive treatment, and that includes helping them understand their dental plans. Good practices are able to work with their patients and provide them with these aspects:
Detailed Explanations: During your appointment, your dentist should be able to explain your treatments, their costs, and what your insurance will cover when you receive your treatment.
Co-payments Upfront: Dental practices should present co-payments upfront to their patients to ensure less hassle.
Patient Advocacy: When communicating with dental insurance companies, they should advocate for their patient’s health when assessing the costs and submitting claims.
Overall, learning about how your insurance works will help you during your appointments and give you a better opportunity to have more positive interactions with your dentist.