There is a reason so many dental offices have dedicated team members who are knowledgeable and well-versed when it comes to insurance. While patients are busy trying to better understand their treatment plan, the added stress of filing paperwork and claims as well as knowing whether a particular procedure is covered can be exhausting and overwhelming. Fortunately, there are a few simple tips a local dentist recommends that will help individuals like yourself become more familiar with the basics of dental insurance. Read on to find out what you should know so you can start maximizing your benefits.
1. Take Time to Understand Your Plan
When enrolling in a particular dental insurance plan, understand that what is covered in your policy will likely look far different from a neighbor, friend, or colleague. Everything from your deductible, monthly premium, and yearly maximum may be different as well as the UCR (Usual Customary and Reasonable) charge, which are the set amounts your insurance company will allow for certain services (i.e. 80% for minor restorative services). Knowing more about the details of your plan will ensure you are prepared when it comes to paying for treatment or any necessary fees.
2. You Have the Freedom to Choose Your Provider
If you do not want your dental insurance company dictating who you see for maintaining and improving your smile, make sure to opt for a PPO plan. By definition, PPO stands for “Preferred Provider Organization,” which means you get to choose who you want to see for necessary dental care. Of course, if you are struggling to choose between two providers, you may wish to review the differences in coverage. Is one in-network and one out-of-network? If so, you’ll need to determine if which is more important – cost or quality?
3. You Can Choose to See an Out-of-Network Provider
Most dental insurance companies will encourage clients to find an in-network provider. Why? Because you will save the most money; however, if your dentist is out-of-network, it doesn’t mean you have to switch or will no longer receive coverage. In actuality, most companies have a slight difference in what is covered based on whether you choose a dentist who is in-network or out-of-network. Oftentimes, the only variation you can expect to see is the insurance company will pay less for the services you receive. You can still expect, in most cases, to be covered in some way, but you will likely have to pay more out of pocket for treatment.
4. You are the Customer, Not the Dental Practice
Say for example you are required to pay for treatment in full at the time services are rendered. You can expect your dental insurance company to reimburse you directly. They will also be more likely to pay you back much quicker than they do the dentist’s office. If you or a member of your dental team submits an electronic claim on your behalf, it can take a few weeks to be reimbursed but should take no longer than one month.
Navigating your dental insurance policy shouldn’t cause you to stress or feel discouraged. By taking the time to review your policy, in full, and better understand what you have control over, you can feel confident making the right decisions about your dental health.
About the Author
Dr. Venn Peterson attended the University of Washington School of Dentistry, graduating in 2000. Practicing in Lacey since 2001, he and his colleague, Dr. Spenser Cammack, who earned his dental education at The Ohio State University College of Dentistry, want to help you and your loved ones maintain healthy, beautiful smiles. While dental work can be costly, they believe in offering affordable services for everyone in need. Whether it is helping you maximize your benefits or provide available financing through CareCredit, let us make the financial aspects of your treatment as stress-free as possible by calling our office at (360) 459-4420.