For dentists and patients, dental insurance contains an array of complicated policies and features that can be a real struggle to understand. Dental plans can vary from individual, and because of these variances, dentists have to work with both the insurance company and the patient to gain a better understanding of what treatments are covered, what co-payments need to be made, and how to process claims to assure patients that they get the benefits their insurance covers. Companies such as Delta Dental, Humana, and Cigna hold a significant portion of the insurance market due to their widespread over the United States. While it can be convenient for patients with these insurance companies, understanding how these giant corporations work to process claims can make a person quite bewildered.

As a dental practice, we strive to work with outpatients with exceptional care. Part of caring for our patients includes helping patients through their dental insurance and creating a treatment plan that works with both their health needs and their insurance companies. Here’s our breakdown of how dental insurance works and dentists like us help patients get the treatment they need.

Understanding The Benefits of Insurance

Depending on the company you use, your benefit will vary. The dental insurance market doesn’t just cater to variety but includes people of all different income levels. While you may have certain benefits, the person next to you will have completely other benefits. With each patient who arrives throughout our office, we ask for your dental insurance information to determine your coverage and what those benefits contain. Attaining this information allows our practice and many other practices to assess those benefits and work with you to gain the treatments you need.

One essential aspect to note about dental plans is that they do not determine what treatments you can get. Your dental plan only lists what your insurance covers, and when dentists recommend treatments outside of your coverage, one tip you can do to help reduce the costs is set up a predetermination, or a pre-treatment plan, to submit to your insurance company so they can help assess the costs and coverage of your overall treatment. These pre-treatment plans will also list vital information about your coverage, including:

  • Your specific treatment plan
  • Your explanation of benefits
  • Accurate out-of-pocket estimate
  • Your maximums and deductibles
  • Reimbursement levels

These aspects can be detailed by your insurance company to show what treatments they’ll cover, what treatments you will be billed for, and allow us to help modify the treatment plan to suit your needs. However, certain aspects of this listing often confuse patients the most, and below, we’ll list out what these insurance terms mean and how they impact your dental coverage.

Things to Know About Your Plan

Specific terminology used often in insurance takes on a whole new meaning for patients receiving the dental care they need. These terms include:

  • Deductibles: Your deductibles will pay the insurance company before treatment begins. These payments work to reduce the amount you need to pay for co-payments and allow dental practices to submit claims to help reduce treatment costs.
  • Maximums: Your maximums will show your monetary limit for your treatments. Once you reach the maximum limit, you’ll have to pay out-of-pocket for the remaining balance.
  • Dual Coverage: If you have more than one coverage plan, then the primary plan will pay for your treatment plan first, with the secondary covering for other procedures. These plans cannot exceed 100% of the payments, and the secondary plan will act as a backup for out-of-pocket expenses.
  • Reimbursements: Some fee-for-service plans use repayments as a way to cover costs. Reimbursements work to cover a certain percentage of treatment costs, including major procedures such as crowns and implants.

There are many more aspects of insurance that can work in your favor and potentially hurt your pocket if not understood. If you’d like to learn about practices tend to handle insurance, then contact Dr. Edward Formica at Dr. Formica in Hemet, CA.

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