Dental insurance is a good way to keep your smile healthy and glamorous for life. According to the National Association of Dental Plans, 77% of Americans have dental benefits. Many people have private insurance coverage mainly offered by employers since Medicare does not cover dental care and state Medicaid programs have a limited cover. However, many people, especially those who just got new insurance do not know where to start when they want to visit a dentist. This article presents five questions to ask your insurance provider before your visit to the dentist. It will help you ask the right questions and know the costs insurance will cover.
1. Is there a waiting period before I can use my insurance
Some insurance policies have waiting periods while others do not. Before you head to the dentist, you must ask your insurance provider whether you have to wait for a certain period to enjoy your insurance benefits. For example, you just got your dental insurance cover. One week down the line, your tooth breaks and you need a crown. If your insurance has a 12-month waiting period for crowns, it means you have to wait for one full year for the insurance to cover it. However, you can still have the crown on your bill.
2. Do I choose my own dentist or have to visit a particular dentist?
This depends on your dental plan. While some plans allow you to choose your dentist, others restrict you to a selected group of dentists. Just like health insurance plans, there are different types of dental plans. The most common include;
- Preferred Provider Organization (PPO): this plan contains a list of dentists that accept the plan. Nevertheless, you can choose a dentist out of the network but be ready to incur additional out-of-pocket costs.
- Dental Health Maintenance Organization (HMO): this plan comes with a list of dentists that accept the plan in exchange for stipulated co-pay or no fee at all. You cannot visit a dentist outside the network with this plan.
- Discount or referral dental plan: although this plan does not pay anything for your dental care, you get discounts on dental services from a network of dentists.
3. How much do I pay for services and procedures?
Many dental plans have a 100-80-50 coverage structure. For preventative care –cleaning, x-ray, they cover 100% of the costs while for basic procedures –minor fillings- they cover 80%. For major procedures like crowns and bridges, dental plans cover 50% of the costs or require you to pay larger co-pay. However, these percentages vary from one insurance policy to another and depend on whether you stay in the “network” or “go out of the network.” It is good to ask your insurance provider the amount you should pay for each office visit and procedure.
4. What procedures are covered?
Dental insurance covers many procedures and excludes some. While many insurance plans cater for basic services such as extraction, cleaning, exam, and routine check-ups, some providers exclude major treatments like implants, braces, dentures, and bridges. Other dental policies do not cover preexisting conditions. You must ask your insurance provider the procedures you are covered for so that you plan your visit. For example, if your insurance covers only 50% of a procedure, you will know how to raise the remaining 50%.
5. How often can I see a dentist using my dental plan?
Most insurance covers allow you to see a doctor every six months. For major treatments, they allow for multiple visits. Nevertheless, every dental plan has a cap of what it will pay in a year. Most PPOs have a cap of $1,500 and you cater for any amount above the limit.
Dental insurance is important because it improves your health, gives you peace of mind, and saves costs. However, it does not cover all things dental and hence it is important to talk to your insurance provider before you visit a dentist. You wouldn’t like to have a cosmetic dental procedure only to find out that it is on your bill, not your insurers. This article equips you will five insurance questions to ask your provider so that you make the most out of your insurance cover when you visit a dentist. Contact North Boulder Dental Group to know how you can get world-class dental services affordably.