Making the most of your insurance coverage isn’t very hard to do, but it does take some analyzing to understand the specific areas of coverage, percentage of fees covered, and what type of procedures are billable.
Most dental offices will file your insurance claims as a courtesy to their patents. These allows them to better serve their patients and make it easier for them to be seen at the office (after all, how would you like to file your own insurance plans every time?) Unfortunately, this creates the misconception that dental offices can make a tremendous difference in the amount of coverage you have at their office. Truth be told, only your human resources department (or yourself, if you are self-insured) can negotiate the type of coverage that you have on your dental plan. The fee schedule, deductibles and percentages paid are all negotiated between your employer’s HR and the insurance company.
The majority of dental insurance plans cover preventive care appointments at 100%, allowing you to receive routine cleanings and check-ups twice each year. This promotes better oral health, because it allows your dentist to diagnose needs like cavities or gum disease early on, where they are simpler and cheaper to correct. More significant treatment like fillings or crowns may only be covered at 50-80%, depending on your plan. To make this even more confusing, your insurance plan may be on a fee schedule that says they pay 80-100% of a certain procedure, but that is based on the insurance’s allowable procedure fee.
Getting a detailed treatment plan from your dentist can help you understand what portions you owe out of pocket for your care. For best results, get routine preventive dental care every 6 months!
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