Understanding and Maximizing Your Dental Insurance
California Dental Group can help you maximize benefits under a variety of insurance plans.
Today’s healthcare marketplace operates on the presumption that most people have insurance. If you don’t have coverage, you are missing out on the opportunity to get the best care at the best price.
Fortunately, with a little bit of planning, you can not only find quality dental coverage but also maximize that coverage so you get the best possible value from your insurance plan.
Understanding Your Coverage
In order to understand how your out of pocket costs compare to the value of the coverage provided by your dental insurance, you need to understand these key terms.
Premium: Your premium is basically the cost of enrollment in the dental insurance plan. It is typically paid in monthly installments.
Deductible: Dental insurance plans require you to pay a deductible of anywhere from $25 to $100 out of your own pocket before they will start providing coverage for restorative dental work. This deductible must only be met once per year.
Level of Coverage: With the exception of annual dental cleanings and exams (which are typically covered at 100 percent with no deductible) most dental insurance plans only cover a portion of the cost of your restorative dental treatments. Depending on your plan, you may have to pay for 40 to 60 percent of services like crowns and fillings out of your own pocket.
Annual Maximum: Dental insurance plans do not provide unlimited coverage. Instead, they will only pay out up to a certain annual maximum, typically somewhere between $1,500 and $2,500. If you need to spend more on your dental care in a given year, you will need to pay out of pocket.
How to Maximize Your Insurance Coverage
Find a Dentist that Accepts Your Insurance: Obviously the first step to maximizing your dental insurance is finding a dentist that accepts your plan. However, you should really go beyond mere acceptance and look for a dentist that is actually a PPO (preferred provider organization) for your plan. Insurance providers have negotiated special rates with their PPO dentists and this may translate into lower out of pocket costs for you. At California Dental Group, we accept a wide variety of PPO plans—just call us to find out if we accept your insurance.
Schedule a Dental Visit: The next step is to make an appointment to see the dentist for a cleaning and exam. Most plans provide one free cleaning and exam each year, so if you don’t use it, you are basically throwing away the money you spent on your premiums.
Your cleaning and exam will also provide an opportunity to discuss additional dental work you want or need to get done with an expert dentist. The dentist can prepare a detailed cost estimate for this care. Then, the estimate can be submitted to the insurance company for pre-approval so that you will have an even better idea of how much your care will cost out of pocket.
Work with a Care Coordinator: Our care coordinators can provide expert insights into how to plan and bill your dental procedures so that you receive the maximum benefit from your insurance. Some common strategies we may suggest include:
- Using “alternate benefit” coverage (if available) to help with the cost of procedures like dental implants
- Unbundling services so that they can be billed and reimbursed individually (like if you had x-rays and extractions)
- Scheduling multi-visit procedures in two different calendar years so that you use up two different annual maximums
Ready to Learn More?
If you would like personalized advice about receiving care under your specific dental insurance plan, please contact us today to set up an appointment.
