Here we have compiled some frequently asked questions regarding dental and medical insurances. We hope these will help you understand the role of dental insurance a little better. Feel free to contact our treatment coordinator at any time for any questions that you may have.
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Dealing with dental and medical insurance can sometimes be frustrating. It is difficult to know exactly what is covered and what is not.
Over the years, patient’s expectations and demand for dental services have increased, however, dental care covered by dental benefit plans is comparatively limited.
Unlike medical insurance, which gives you a million dollar lifetime maximum, most dental plans provide a small yearly allowance. The average allowance is $1,000. That amount helps patients secure some of the needed care but not all. There may be deductible and co-insurance involved. It may also provide for two preventative visits per year.
The higher the premium paid by you and/or your employer, the more percentage, as well as variety of dental services, will be covered.
If you have any concerns regarding your dental Insurance benefit, our treatment coordinator would be happy to sit down with you and answer any questions that you may have.
Please keep in mind that insurance companies are not dental “experts.”
At Santa Teresa Dental, we prescribe the treatment that is optimum for your oral health. We absolutely do not allow the insurance companies to dictate a patient’s treatment plan. There may be recommendations that are not covered by your dental benefit plans. However, it does not mean that it is not needed. It simply indicates that those procedures were the specific exclusions of your policy.
The easiest way to find out what your insurance will cover is to call your insurance company directly. You will find an insurance questionnaire form in your new patient package, which can be used as a guide.
Our insurance coordinators are certified in dental insurance coding and medical cross-coding by Warschaw Learning Institute. We are very familiar with most current dental and medical codes.
We will provide all documentation needed, which often includes radiographs, intraoral images, models, gum charting and letter of medical necessity.
We submit all claims electronically. When a claim is denied, we investigate the reasons and appeal on your behalf.
Costs not paid by dental benefit plans are the patient’s responsibility.
If you are covered under two dental insurances, you may be assured full benefits where benefits overlap, and where the other plan lists as exclusion. However, pay attention to terms such as “limited coordination of benefit” and “non-duplication of benefit.”
Groups with a non-duplication of benefits rule in their plan only allow the secondary carrier to pay the difference between what the primary carrier actually paid and what the secondary carrier would have paid if it had been the primary carrier.
In most cases, dental insurance plans do not cover cosmetic procedures, such as veneers and teeth whitening.
When there are many treatment options available, most insurance companies opt to make reimbursement for the lowest cost option.
For example, insurance plans often pay for amalgam (silver) fillings and not tooth color fillings for the back molars. The tooth color fillings are considered cosmetic in this case. Patients will pay for the difference in cost.