Many of our patients in Parma Heights, Parma, and Cleveland ask us to explain dental insurance to them. It’s not always easy to understand! If you have dental insurance, you have a very powerful tool for maintaining good oral health, but many people don’t understand how their insurance policies work. The best way for you to take full advantage of that asset is in understanding your dental insurance coverage.
Dental Insurance Maximums
Most dental plans have an annual dollar maximum, which is the maximum amount the plan will pay towards the cost of your dental care within a specified benefits period (typically January through December). You’re personally responsible for any costs that are beyond the maximum.
Dental Insurance Deductibles
Most dental plans have a specific dollar deductible. This is the amount you must pay toward your dental bill before the plan begins paying. Some plans apply the deductible to diagnostic or preventive treatments while others don’t. Check with your insurance company to determine the deductible amounts and which service they apply.
Coinsurance & Copays
Coinsurance is your share of the cost of a service. Your plan will pay a pre-determined percentage of the cost, and you handle the rest. You start paying coinsurance after you’ve paid your deductible. A copay is a fixed amount you pay for a service, usually when you receive the service.
Understanding Reimbursement Levels
Most plans cover three different types of service:
- Preventive & Diagnostic Services (Class I) – These services include exams, cleanings, x-rays, and fluoride treatments. They’re typically covered at the highest percentage (for example, 80 to 100 percent of the plan’s approved fee) and is set-up to actively encourage you to seek preventive care.
- Basic Services (Class II) – Basic services include fillings, extractions, sealants, and root canal treatments. They’re sometimes reimbursed at a slightly lower percentage (for example, 70 percent).
- Major Services (Class III) – Crowns, dentures, fixed bridges, and implants are considered major dental services. They’re usually reimbursed at a lower percentage (for example, 50 percent) and may have a waiting period before services are covered.
If you require extensive dental care, ask your dentist to submit a request for a pre-treatment estimate. This way you’ll know in advance which procedures are covered, what the plan will pay, and what you’re required to pay. Keep in mind that a pre-treatment estimate is not a guarantee of payment.
Limitations and Exclusions
Dental plans are designed to help with some of your dental expenses but most don’t cover every dental need. It’s important to be aware of your plans limitations and exclusions.
There is a misperception that you only need treatment approved by your insurance company, but this isn’t necessarily true.. Again, dental plans are designed to help cover some treatments, but not all treatments necessary to maintain good oral health.
Don’t put off a treatment solely because it’s not covered. If you have difficulty affording it, discuss with your dentist what financing options might be available.
Take some time to review your plan, so you have a good understanding of your dental coverage!
Dental Services in Parma Heights, Ohio
Kenneth J. Wolnik, DDS practices general dentistry in Parma Heights, Ohio. In addition to providing dental cleaning and fillings, Dr. Wolnik also specializes in cosmetic and restorative dentistry, as well as, sleep apnea treatment. Give us a call at (440) 888-5055, email us at email@example.com or contact us online!
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