dental insurance

adult braces

Dental Insurance is complex, to say the least. It is nothing like medical insurance, and a common misconception is that there are set copays for services and that everything gets approved by insurance, but the truth is, dental insurance is in its own realm. In an ideal world, dental insurance would not matter, but let’s be real, insurance for some people is a necessity.

First: Dental insurance works off coinsurances and what that means is dental insurance companies will pay a portion of the claim submitted based on certain percentages. A standard dental plan is 100% coverage for preventative services (things like cleanings, most x-rays, etc.), 80% for basic services (fillings, periodontics, etc.), and 50% for major services (crowns, dentures, etc.).

Second: Fillings, cleanings, root canals, oral surgery, and even orthodontics all have different coverage allowances and amounts. And all dental plans are different, it is very important to look into your plan to see whether that cavity you’re getting filled is covered at 100% or 20% or you could be stuck with a bill you weren’t expecting. The one thing insurances hate most is an informed patient.

Third: Waiting periods and missing tooth clause are very real conditions on some plans, and very important if you are an insurance-based patient. Some insurance plans will have a waiting period you have to meet before they will cover certain services. This could mean before you get that set of x-rays, you could have to wait 6 months of being insured before the insurance will kick in for the service. A missing tooth clause is a clause that insurance companies will add that states that they will not consider any treatment to a tooth that was missing prior to the effective date, or will make you wait 12 months before they will consider coverage, sort of like a waiting period.

Fourth: A deductible could apply to your visit. Certain companies will apply a $50 (or more) deductible prior to them covering services. Most people also don’t know that this deductible could apply to anything from x-rays to crowns, depending on your dental policy.

Fifth: Finally, insurance companies are quick to deny services and claims take several weeks to process. It’s important to stay informed and stay on top of your insurance company. Most dental offices are working hours upon hours behind the scenes to get your insurance claims paid and any help they can get really helps a lot.

If you have questions regarding insurance please feel to give us a call at 775-376-7914 or fill out our contact form.



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