Dental insurance plans vary widely. Understanding your dental insurance benefits can be complicated. At Axiom Dentistry, our experienced patient care coordinators strive to assist you in better understanding your benefits. We want to help you get the most from your dental insurance plan.
What are maximums, deductibles, and coinsurance?
Most insurance plans have some or all three of these conditions:
Dental plans have a maximum dollar amount that can be paid out during a benefit year. Any costs above this maximum amount are the full responsibility of the policy holder.
Just like your car insurance, most dental plans have a deductible that must be met before the dental insurance will contribute.
Dental insurance plans pay a percentage of your dental services once the deductible has been met up to the maximum dollar amount. Most services fall under one of the following coinsurance categories:
- Preventative- Routine cleanings, examinations, x-rays, sealants, and fluoride
- Basic or Restorative- Fillings and simple extractions
- Major- Crowns, bridges, partials, dentures, and surgical extractions
Root canals and periodontal treatments such as “deep cleanings” can be classified as basic or major services depending on your individual policy.
If your dental service is $122.00 and you have a standard $50.00 deductible and 20% coinsurance your dental insurance will pay $57.60.
What is an In-Network provider and how does this benefit me?
An in-network provider is contracted with an insurance company to provide services to plan members for a specific pre-negotiated rate. When you visit an in-network provider you will only be charged the contracted fees that your dentist has agreed to accept.
When you visit a dentist outside of your network you may be charged higher fees because the provider has not agreed to any set rate with your insurer. You will also be responsible for the difference between your insurers contracted rate and what the provider charges. Most plans also require a higher co pay and deductible when you visit an out of network provider.
What about the fine print?
There are a few other “fine print” conditions that might affect your insurance reimbursement. The following list is a few that are common to many plans:
These limits dictate the number of exams, cleanings, x-rays, and other services that your plan will pay during a year. Any additional services outside of these limitations will be the responsibility of the insured.
The amount of time that an insured must wait before the insurance carrier begins to pay for services. This is commonly six months to a year.
Missing Tooth Clause
This clause states that the insurance company will not pay for a tooth to be replaced (dentures, partials, implants, or bridges) that was missing prior to becoming covered by the plan.
The time period a patient must wait to replace an older crown, bridge, partial, or denture. This usually amounts to 5-10 years.
Axiom Dentistry is an in-network provider with most insurance companies. Our dedicated professionals will work with you to better understand and utilize your benefits. Contact Axiom Dentistry to learn how your insurance can work for you!
No dental insurance? Axiom Dentistry offers a variety of helpful alternatives including the Axiom Membership Plan.