Dental Benefits: Friend or Foe?

Tricky in Nature

At its root, using dental benefits can definitely help lower the out-of-pocket cost of dental treatment. However, dental insurance is more complex than the common misunderstanding that it will pay 100% for everything. The biggest obstacle is that hundreds of different dental insurance companies exist and within those companies, there are various plans with multiple underlying limitations. We don’t claim to be insurance experts, but noticeable patterns with dental insurance can be used as a rule of thumb to help understand the tricky ways of our coverage a little better.

Knowledge is Power with Dental Benefits

Your dental front office team will do their very best to get everything right with your insurance benefits, the sneaky limitations, and receiving payment. Since there are so many insurance companies and so many plans, it is not always possible to get everything perfect. Your best defense in using dental insurance is to know your benefits. That way there are fewer surprises and less confusion. Knowledge is power, especially for your pocketbook!

Many people tend to believe dental insurance covers 100% of treatment or close to it. Sadly, insurance will only pay a percentage, which often varies depending on the insurance plan. It is important to know that a trend for insurance coverage is observable in the percentages paid, and it is even easy to understand!

1. 50% Coverage (more extensive treatment): Crowns, Implants, Dentures, Oral Surgery, Root Canals
2. 80% Coverage (less extensive treatment): Fillings, periodontal cleanings, basic extractions
3. 100% Coverage (services that prevent problems a.k.a. preventative): Cleanings, Exams, X-rays

See? Easy? The challenge with this coverage model is that it is just a trend. Not all plans follow these percentages. For example, some plans may use 70% instead of 80% for the less extensive treatment category. You could also see that some plans cover extractions at, let’s say, 50% instead of 80%.

Also keep in mind that most plans cover preventative services two times per calendar year (January to December). Again, this is only the usual song-and-dance. Sometimes a regular cleaning may be covered 1 time per year instead of the recommended 2 times. Sneaky, sneaky, right?

Of course, there are other obstacles with dental insurance to be on alert for. Deductibles usually ranging between $25 to $100 have to be met before insurance pays for any treatment. Then there are Annual Maximums limiting how much you can use in a year. If your Annual Maximum is $2500, then insurance will only pay up to that amount in 2018.

The End is Near

Here’s the other thing. Dental insurance benefits don’t roll into the next year. If you don’t use them, you quite literally will lose them. That’s potentially a few thousand dollars you could use towards needed treatment. Ouch! While we don’t base treatment off of what insurance covers, we completely understand that it can help you out financially. If you have them, we want you to use them! There’s nothing worse than that feeling of money going down the tubes, so contact us today and use those benefits before the year’s end!