Insurances

Patient Education- Dental Insurance FAQ

A dental insurance policy is a contract between the patient and the insurance company. It is designed to pay for a portion of dental treatment. In other words, patient is sharing the cost of treatment with the insurance company and the amount not covered by the policy is patient’s responsibility.

A deductible is the amount of money patient has to pay before insurance starts paying for the treatment. A copayment is the estimated portion that insurance will not cover for your procedure, and is due on the day of treatment. Each company has it’s own coverage percentage for a treatment, but payment is not always guaranteed or covered fully to that amount. We send the claims out after the procedure is completed, and then after receiving their payment, will let you know if you have a remaining balance or credit.

A yearly maximum is the total amount insurance will pay for an individual’s treatment during a specific benefit period. It is typically by calendar year (January to December), but the cycle can also start on any day of the year.

A lifetime maximum often applies for major procedures such as orthodontics. In those cases, the patient is only eligible for coverage once for a lifetime.

Dental plans do not cover every dental procedure. Covered benefits and benefit levels vary by insurance policy. Each plan contains a list of conditions or circumstances that limit or exclude services from coverage. Limitations may be related to time or frequency (the number of procedures permitted during a stated period) — for example, no more than two cleanings in 12 months or one cleaning every six months. Exclusions are dental services that are not covered by the plan. Cosmetic treatment such as whitening and veneers fall under this category.

We highly recommend sending in a pre-authorization for any major treatments. Insurance company will review the pre-authorization the way they review a claim and therefore will be able provide patient a more accurate estimate.

Most insurance companies provide online access to member’s account, which allow patients to look up information such as remaining maximum, deductible and benefit level etc on their websites. Patients can also find out more information about their plans by calling the customer service number of the insurance company. The toll free number is usually located on the membership card.

1)     Subscriber’s ID/ SSN
2)     Subscriber’s DOB (Date of Birth)
3)     Patient’s DOB

Reference:

Insurance Terms. Delta Dental, n.d. Web. 13 Oct. 2014.