Dental insurance is designed to pay for a specific portion of dental services, such as routine exams and cleanings, x-rays and restorations. Dental insurance policies are contracts between you and an insurance company and are negotiated by an employer or union (the plan’s sponsor). Unfortunately, we have no control over these contracts and no input into the fees your insurance company will pay on your behalf.
We will be happy to help you plan your treatment so you can maximize your insurance benefits. We bill your dental insurance company on your behalf and submit all the required paperwork and documentation. We are also able to “pre-authorize” treatment to receive information about specific coverage from the insurance company.
Your dental insurance has an annual maximum benefit amount and your coverage will end, or be “maxed out” each year once this amount has been paid. Yearly maximums cannot be carried over into the next year if you do not use all the allotted benefits within the specified time.
Many insurance plans describe their coverage by stating that they pay 80% or 100% of a “fee schedule.” These fee schedules represent arbitrary, discounted amounts decided by insurance companies and they do not reflect the actual fees charged by dental offices. It is our experience that insurance companies who pay according to “fee schedules” usually cover between 25% and 40% of the actual fee.
If you have any question about your coverage please contact us and we will be happy to check the details of your insurance plan using our specialized software program and explain the limits of your coverage. If you are deciding between several insurance plans during an open enrollment period please call our office for guidance on choosing the plan that will best suit your needs.