September 27, 2020
You pay for it every month, and you probably know that it’s important, but do you really understand how your dental insurance works? If Dental insurance policies, plans, terms, and details confuse you, you’re not alone! Many patients don’t fully understand their benefits, and as a result, end up avoiding, delaying, or overpaying for their dental work. Read on as your Horseshoe Bay dentist shares five tips for understanding and making the most of your dental insurance plan.
1.) Know the Difference Between Co-Payments & Coinsurance
While these two terms may sound similar, they aren’t exactly the same. A co-payment is usually a flat fee that you’ll need to pay per visit to your dentist. Coinsurance on the other hand, is the percentage of a specific treatment that you’ll need to pay for. If your plan includes 20% coinsurance for fillings, then your insurance will pay 80% of the cost of your treatment and you will be billed the remaining 20%.
2.) Keep in Mind What Your Annual Maximum and Deductible Are
Two very important terms to understand and numbers to keep in mind are:
- Annual maximum: This is the maximum amount your plan will pay for toward the cost of all your dental care within the year.
- Deductible: This is the amount you must pay out of pocket for your dental care before your insurance policy begins to pay for your treatments.
Generally speaking, the lower your deductible is, the lower your annual maximum is as well.
3.) Remember That “Out of Network” Doesn’t Mean “Out of Coverage”
If a dental practice is “in-network” for you, that means they have agreed to your insurance provider’s fees for treatment plans. It’s highly recommended that you stay in-network for the most cost-effective care. However, out of network doesn’t necessarily mean out of coverage. Getting care from an out of network dental practice simply means that the percentage of treatment your insurance covers may be reduced.
4.) Always Ask for a “Pre-Determination” of Benefits
Before having a dental treatment that goes above and beyond a regular checkup, ask your dentist to send a “pre-determination” of benefits to your insurance company. They’ll process the estimate and send back a statement that shows exactly what your insurance plan would cover for this treatment. This way, you’ll know exactly what to expect when it’s time to pay for your procedure.
5.) Don’t Let Your Biannual Dental Checkups Go to Waste
Dental insurance plans typically cover different services at different percentages, or reimbursement levels, such as:
- 100% of preventive and diagnostic services, such as routine checkups.
- 70-80% of basic restorative treatments like root canals, fillings, and extractions.
- 45-50% of major procedures including crowns, bridges, and dentures.
Regular dental checkups are the best way to spot and stop issues as early as possible, before they have a chance to become larger, more complicated, and more expensive problems. Skipping these simple biannual visits could cost you in the long run, so take advantage of them!
It’s important to keep in mind that every dental insurance policy is different, so you’ll need to go over your specific plan to fully understand what it covers. If you need help, your Horseshoe Bay dentist and their team would be happy to review your policy and help you make the most out of your benefits.
About the Practice
Our talented, friendly, and highly experienced team here at Horseshoe Bay Dental always goes above and beyond to make oral health care as pleasant, easy, and affordable as possible. We’re proud to accept a wide variety of dental insurance providers and have helped countless patients maximize their benefits. If you don’t have dental insurance, we offer a Loyalty Membership Plan and financing through CareCredit to make great oral health an achievable goal for everyone! To find out more, we can be contacted via our website or at (830) 598-5474.
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