Buying Dental Insurance
When buying dental insurance, what should I look for? The most tricky terms that insurance companies use in contracts that can result in non-payment
1.Coverage: Just because everything is covered does not mean everything is paid for; they are typically only covered to a certain extent.
2.Terms and Conditions are very critical: YOU SHOULD NOT INCLUDE THEM IN YOUR PLAN. IF YOU DO, COSTS MAY BE HIGHER, OR YOU WILL PAY FULL FEES.
3.Waiting period: This means that your procedure will only be covered after 6 to 12 months, and you will have to pay for everything until then.
4.Missing teeth clause:
In other words, this refers to when a tooth is extracted or is missing, and you purchase an insurance plan. Insurance does not cover the replacement of missing teeth (bridge, denture, partial). In simpler terms, this means that preexisting conditions are not covered.
5.Downgrade Factors
It is common for insurance companies to increase your copay by as much as $10, and they will indirectly pay for similar low-cost services and similar outcomes or a low-cost tooth replacement.
Example 1: Back teeth silver fillings will be covered by insurance, but not white fillings. Similarly, white or porcelain crowns are not used on back teeth, as they are not visible.
Co payment Calculation
1. Procedure code: Dentist can provide, or you can find out.
2. Procedure code cost: Insurance can provide this information
3. Breakdown of benefits: This shows what your insurance covers as a percentage of your treatment costs or procedure codes.
· optional: calculator
There are a few terms that you should know before you calculate to determine what information you need.
Standard fee schedule OR Fees OR Charges = Dentist office fees/cost that you are charged if you don’t have any insurance.
Contracted fees/allowance OR Insurance fees OR MPA (Maximum plan allowance = Insurance contracted fees with the particular dental office (varies from office to office)
Coverage of Benefits (breakdown of benefits) = defines the contribution of individual and insurance.
For example, if fillings are covered at 80%, the insurance will pay 80%, and the patient will be responsible for 20%.
Deductible = any individual’s amount to pay before any insurance payments.
Benefits explained: once a claim is processed and payment is sent with a breakdown of how much is covered by insurance and the individual’s responsibility.
SHORTLY,
| Procedure Code for Crown | Office Fees | Insurance negotiated fees | Insurance Coverage | Insurance Payment portion | Patient payment portion | Loss to dentist |
| D270 | 1000 | 900 | 50% | 450 | 450 | 100 |
If you have to pay deductibles or your insurance downgrades or deny your claim, your payment portion will increase, but you will pay the maximum amount will be $900.
Accepted insurance
