At Jones Bridge Dental Care, we get many, many questions about dental insurance coverage and for what procedures our patients are covered. We do work very hard to help answer these questions, and of course, will work with your insurance company, too! So no matter if you have coverage provided by Delta Dental, Cigna, Blue Cross, or any of the dozens of other insurance companies we work with, we thought we’d answer a few basic questions to get you started.
“WILL MY INSURANCE COVER THIS?”
Dental insurance is not the same as your medical insurance in that it will cover all necessary care. Dental plans are designed to help defray the costs of dental treatment. Typically, plans cover varying percentages of treatment, but not necessarily all treatment. Dental insurance is a contract between your employer and an insurance company. The more you and your employer pay for the insurance, the higher the percentage of coverage and the more procedures that it will cover.
“HOW DO I FIND OUT WHAT MY INSURANCE COVERS?”
Your plan sponsor or human resource department should provide you with information that defines copayments, exclusions, limitations and annual maximums. We will gladly provide estimates for you based upon what the average plan pays. Please understand there are many different insurance plans and there are different levels of coverage within the same company where you work. We like to tell patients: “Every family in our practice has a different plan with different reimbursement and eligibility levels.”
“I CAN FINALLY HAVE ALL MY DENTAL TREATMENT DONE!”
You can, and Jones Bridge Dental Care wants to provide it for you! However, most insurance plans have annual reimbursement maximums that have not changed since the inception of dental insurance in the 1960’s. Once you exceed your “annual maximum,” no treatment will be covered by your insurance. You need to know whether your “annual year” is based upon the calendar year, your hire date, fiscal year, etc. This is an important consideration for us, as we want to help you maximize your benefits. Likewise, many plans have “frequency exclusions”. Some insurance companies allow a cleaning once in 6 months, and not a day sooner.
“I’LL JUST WAIT UNTIL NEXT YEAR SO MY INSURANCE WILL COVER IT …”
Don’t delay needed treatment with the assumption that insurance will cover more if you wait until the next “annual year.” We often see patients delay treatment for months and have the treatment become more complicated and costly. These patients ultimately spend more time in the dental office and pay more out-of pocket than had they had the treatment performed when it was recommended. Let’s talk about your specific needs and weigh the risks of delaying treatment. It is sometimes possible to delay care, to maximize insurance benefits, without the risk of the care becoming more costly and complicated.
“MY INSURANCE COMPANY SAID THEY WOULD ONLY PAY FOR THE LEAST EXPENSIVE ALTERNATIVE TREATMENT”
The “fine print” of most insurance plans allows them to substitute the payment of treatment for the least expensive treatment alternative. Again, an issue of the contract negotiated between your employer and an insurance company, based upon the costs of the plan. As with many things in life, the least expensive may not be the best. Over the period of your lifetime, the least expensive treatment now might be more costly in the long run.
“DO YOU TAKE MY INSURANCE?”
You ultimately have the choice to go to any dentist. The question then becomes, “what amount of reimbursement can I expect for treatment by a non-provider.” Patients belonging to Preferred Provider Organization (PPO) programs generally receive some level of reimbursement if they see a “non-participating” dentist. At Jones Bridge Dental Care, we will always provide you with a treatment plan, and estimate what your insurance will pay. Please remember it is an estimate based on what the average plan pays. You have a choice. We would hope that you would choose a quality driven practice and maximize the benefits you are entitled.
If you have additional questions not answered here, please don’t hesitate to call us! No question is too simple or too small, and we will always do our best to help you get the care you need.