October 16, 2017
Dental insurance is about as clear as mud for most of our patients, and that’s not a surprise. Two different people within the same company may have completely different coverage. Unless you deal with dental insurance paperwork on a daily basis, the various acceptable treatments, fair and average pricing, and other policies can be completely baffling. Luckily, a good dentist will help you make the most of your insurance coverage, so many dental patients don’t even have to think about it. As the end of the year approaches, it’s time to take advantage of any remaining dental insurance benefits to ensure you make the most out of your policy.
The Basics of Dental Insurance
Any discussion of dental insurance first needs to consider in-network versus out of network coverage. Most benefit plans allow patients to select any dentist. However, only a specific set of dental offices are considered “in-network.” To be an in-network dental office, the practice has to agree to use specific treatments and materials and charge what the insurance plan deems a “fair and average” price. Simply put, your insurance provider has the power to choose what treatments you receive. An out of network dental practice can recommend and provide any dental treatments and charge prices they deem fair. In many cases, this means patients have increased flexibility to choose treatments they will be happy with and that will look and feel more natural. Unfortunately, this does mean that patients may end up paying more money out of pocket. Insurance providers cover a percentage of their fair cost of treatment, so patients will need to pay the cost of dental care plus the difference between the insurance company’s fair price and that of the out of network dentist.
Plan Maximums & Deductibles
A maximum is the most money an insurance plan will pay for your dental care each year. A deductible is the most money you will need to pay out of pocket in a given year. One of the best ways to maximize dental insurance is to understand how your specific plan handles maximums and deductibles. If you’ve reached your annual deductible without exceeding the maximum plan coverage, it may be time to consider more advanced treatments.
How to Make the Most of Your Insurance Coverage
When it comes to making the most of your dental insurance coverage, taking a few minutes to review your policy details with a trusted dental office may be extremely beneficial. Most insurance plans cover regular preventive care at 100%, so if you haven’t had your two annual checkups, scheduling a second appointment before the end of the year should be your first step. During this checkup, the dentist can discuss your current state of oral health and any treatments you may want to budget for in the coming years. If you’ve already met your plan deductible without reaching your coverage maximum, it may be a good time to invest in dental procedures you’ve been putting off. At the end of the year, your dentist may also be able to split the cost of treatment between two plan years to make the most of your maximums. Rather than completing the entire treatment in the same benefit year, the dentist can complete part of the treatment in one year and part in the next.
Meet Dr. Gray
At the Arlington dental practice of James T. Gray, DDS, our knowledgeable dentist and team would be happy to help you make the most of your remaining year end dental insurance benefits before you lose them! Don’t hesitate to call with questions or to schedule an appointment. We’ll go over your policy documents to compare necessary dental care with your coverage to make sure you receive the maximum benefit from your plan. If you want to find out more about dental insurance coverage or any services we provide, visit our dentistry blog regularly to stay in the know.
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