Monday, May 23, 2016

Dental Insurance 101

Believe or not, insurance is the aspect of dentistry we hear the most questions about. Insurances can be very confusing, and sometimes not very easy to deal with. Our front desk is very experienced and can answer just about any question you have. In this post we hope to answer some general questions. If you have a specific question, or one that isn’t addressed here, please write to us. If we don't know the answer, we will find it for you.

One of the trickiest things about insurance is the whole network thing. Unless a plan is particularly restrictive, most patients can choose their own dentist. We participate in most Delta Dental and Blue Cross Blue Shield networks. A dentist being in-network or out-of-network affects how much of the payment the patient is responsible for; most out-of-network plans will still pay a portion of each procedure, but your portion may be higher. If you have questions about whether we are in your network, your human resources department should be able to tell you for sure.

Every employer chooses what plans to offer its employees, and sometimes one employer will offer different options based on your job within the company. You can’t assume anything about dental insurance; you and your neighbor could both have Delta Dental, but your job might offer one level of coverage and your neighbor’s coverage might be completely different. Most human resource departments will give you a booklet that breaks down what and how much is covered. It’s important to familiarize yourself with your specific insurance plan.

If your insurance allows you to visit us, we’ll figure out exactly what your plan covers. Each insurance policy has different coverage levels and stipulations, so there is no general answer. A quick call to your insurance company will give us a breakdown of your benefits.  This will tell us in broad terms what will be covered and allow us to estimate how much of our fee the plan will cover. We like to have this breakdown before you visit us, so we can accurately explain the financial side of proposed treatment plans. We’ll also review financial options available for work that is not covered by the insurance plan.

If there is a question about whether a specific procedure is covered, or if you’d like to know exactly how much of the fee insurance will cover, we can submit a pre-estimate for you. The insurance company processes the pre-estimate like a claim, and tells us exactly what they will reimburse. It it the only way to guarantee what your coverage will be before you come in. Any other fees we quote you are estimates. A pre-estimate doesn’t force you to complete the treatment plan, but the coverage is guaranteed for a year.

Our office will submit all claims to your insurance for you. One less thing you have to worry about! We also follow-up on any outstanding claims in our system. We take care of as much as we can on our end, but occasionally we do need your help. For example, the insurance company might send a letter to you requesting more information, such as whether you have any other coverage. It’s important to fill out and return these forms to the insurance company, as they often won’t resolve your claim until you do.

As a final thought: You always want to maximize your insurance benefits; you are paying for them! But keep in mind dental insurance companies are not on your side. They occasionally deny necessary or cost-effective treatment based on a black-and-white policy or obscure stipulation. It's important to remember this when you and your dentist look at treatment options. Make the best choice for you. Maximize your insurance, but don't let it tell you what to do!

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