Having dental insurance is great. However having insurance doesn’t always guarantee full coverage. Here is a list of questions you should ask your insurance company to become familiar with your individual plan.
1st: Do I have a deductible and if so how much is it?
What you are paying your employer for your coverage often reflects what your out of pocket costs will be. Deductibles will be collected on your first visit of each year. However some procedures such as cleanings, x-rays, fluorides and exams do not require you to pay a deductible. Ask your insurance provider if preventative services will be deductible free.
2nd: What types of cleanings are covered?
Many patients think insurance companies will cover 2 cleanings every 6 months. If you are diagnosed with healthy gums that is exactly what you’ll need. Nevertheless 75% of the American population has been diagnosed with Periodontal Disease. Periodontal disease requires a different type of cleaning called Scaling and Root Planning, which many people refer to as a “deep cleaning”. After your Scaling and Root Planning patients will usually be placed on a 3month recall called Periodontal Maintenance. Ask your insurance company how many times cleanings per year are covered and whether periodontal maintenance visits are covered. It’s important to remember that if your insurance only covers 2 a year that you will be required to pay for the additional visits. Remember that these visits, if necessary, are important for your health whether the insurance covers them or not.
3rd: Is there a waiting period for major work?
Many insurance companies usually have a waiting period of 12 months or more before they will over certain procedures. Your insurance company can provide you with a list of ADA codes for the procedures that require a waiting period.
4th: What is my plan maximum and what are the percentages I have to pay?
Ask your insurance company what your maximum for the year is. Most insurance companies provide you with a maximum of $1,000-$2,000 annually. This maximum is what the insurance company will pay for services the patient has done in a calendar year. Another question that a patient should ask is what percentages of any procedures they will have to pay after the insurance pays. This will provide the patient with a more accurate total of their out of pocket expense.
Taking the time to ask these 4 questions will help you understand your dental insurance benefits and the procedures your company will cover to help you keep a beautiful and healthy smile.
