Dental insurance plans are unique to each patient. Once your insurance coverage has been confirmed by your company we will strive to optimize the use of your dental benefits. However, it is your responsibility to be aware of exactly what your benefits are.
As a courtesy to our patients, we accept payment directly from the insurance company whenever possible. In many cases, claims can be submitted electronically. Please ensure that your insurance information is up to date so that we can do this efficiently.
Questions and Answers about Dental Insurance Coverage
If you would like, our team will assist you in maximizing your dental insurance benefits.
Please understand that all insurance contracts are between the insurance company, your employer and you; the subscriber. Dental insurance is like a gift card and is not designed to pay for all dental services. The treatment recommended by our team of professionals is based on your individual needs, not what your insurance company will pay.
Managing your dental insurance coverage
Due to the privacy laws dental insurance companies restrict the information shared with dental offices about your insurance coverage. We do not have a direct link to your insurance plan, nor do we know how much your dental insurance might have paid another dental office or specialist office therefore affecting your yearly maximum. We encourage you to become familiar with your dental benefits in order to eliminate disappointments with payment and reimbursement.
If for any reason your insurance carrier has denied or not made payment within 60 days, you are responsible for the balance in full.
The following examples may affect the amount payable towards your dental care:
- Is there a deductible? How much is it?
- What is the percentage paid for basic dental insurance coverage? What is the percentage paid for major dental insurance coverage
- Is your policy on the current fee guide?
- What is your yearly dental insurance maximum?
- When do your dental insurance benefits reset?
- Is root canal therapy covered under basic coverage?
- Are white fillings paid on molars?
- Does your dental insurance plan cover Sealants? On adult teeth as well, or just baby teeth?
- Is dental surgery covered under basic or major?
- Is periodontal care covered under basic?
- Up to what age are children covered under this policy?
- Are dentures, denture repairs and denture relines covered under major coverage?
Dental insurance frequency limitations:
- How many times does your plan cover a recall exam in a year?
- How may times can your plan cover tooth polishing in a year?
- Is fluoride treatment covered by your insurance benefits?
- How may units of scaling (removal of bacterial deposit) does your plan cover in a year? Does your plan cover scaling based on a calendar year or a rolling year?
- How often are panoramic images allowed by your insurance plan?
- What are the limitations for sealants? Will they pay for them more than once per lifetime per tooth?
Please be reminded that your dental insurance benefits are not a treatment plan. All treatment and care decisions are made based upon your actual needs, independent of your dental insurance coverage!