How Does Dental Insurance Work?
Sometimes we hear that our patients are more than a little confused by all the ins & outs of their dental insurance policies.
If you’re a little clueless about how dental insurance works, or by which services are covered and which ones aren’t, let’s see if we can shed some light on the issue.
As we recently discussed in this post, most dental insurance policies expire annually – which means that if you don’t maximize your benefits by using all of the funds available for dental treatment, you lose them altogether!
Individual dental insurance coverage depends on your particular plan, we just thought we’d highlight some of the general guidelines for understanding how dental insurance works.
Wayne NJ dentist Dr. Frank Maldonado and the rest of the team here at our Wayne Dental Arts office know that by helping you understand how dental insurance works, can help you make sure that you are getting the treatment you need, and taking advantage of all of the available benefits.
So let’s dive in to how dental insurance policies work.
What Is a Copay?
A dental insurance copay is the fixed amount specified by your insurance policy that you must pay toward your dental visits.
Copays are required either at the time of your visit or when you receive a bill for the dental treatment you have received – depending on how your particular policy works.
What Is a Deductible?
A deductible is the annual amount that you must pay before your insurance starts covering your dental treatment costs.
Understanding your deductuble amount is of the utmost importance when considering how dental insurance works, and which type of plan is best for you and your needs.
Some people simply need to see visit our office twice a year for routine checkups & teeth cleanings. And some other people require more frequent office visits to address more pressing dental health concerns.
Understanding how your dental insurance works, and especially understanding your deductible & copay will help you maximize coverage while limiting out of pocket costs.
What Dental Treatments Does Your Insurance Cover?
Dental insurance coverage differs from plan to plan, important variables like deductibles, covered treatments, & annual out-of-pocket maximums should all be considered before choosing which option is best for you and your family.
It is common for dental insurances to offer what are known as “100-80-50” plans. What does this mean? It’s shorthand for:
- 100% of preventive and diagnostic services, including semi-annual checkups, cleanings, and x-rays.
- 80% of medically necessary work such as fillings and root canals.
- 50% toward crowns, bridge work, and other procedures.
But remember, this is only an overall approximation and your dental insurance plan certainly may offer more (or less) benefits.
Your best bet is to check your policy for the specific details of your dental insurance or flexible spending account plan.
What’s the Difference Between “In-Network” and “Out-of-Network”?
When insurance companies negotiate contracts with specific dentists (or group practices) they then offer discounts to their patients, these dentists are what is considered to be in-network with that particular insurance plan.
However, patients are not obligated to only see an in-network dentist, even if it may be the more cost-effective option – and remember, sometimes cheaper isn’t always better…especially when we’re talking healthcare.
Out-of-network dentists are just that, they are not part of your dental insurance plan and therefore most likely do not offer any discounts or cost savings related to your particular insurance policy.
However, since most insurance plans differ in coverage, choosing an out-of-network dentist may give you access to more services and treatment options.
If you have any questions about which dental insurance plans we work with here, please ask us about your particular insurance. We can help you determine whether we are in-network or out-of-network for your provider and what exactly that means for your dental treatment plan.
What If I Don’t Have Insurance?
For your convenience we accept Visa, MasterCard, Discover and American Express.
We also offer convenient no interest financing options are available!
CareCredit is a credit card specifically designed to pay for overall & oral health care.
CareCredit offers special financing options for expenses totaling $200 or more. You do not accrue interest as long as you make your minimal monthly payments and pay the full amount by the end of the specified promotion period.
Wayne NJ Dentist Helps You Maximize Your Dental Insurance
At Wayne Dental Arts we make every effort to provide you with the finest care and the most convenient financial options.
To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures.
If you have any problems or questions, please ask our staff. They are well informed and up-to-date. They can be reached by phone at 973-694-8625.
Please call if you have any questions or concerns regarding your initial visit.