Understanding Dental Insurance
In the world of healthcare insurance, there are a lot of misconceptions and misunderstandings when it comes to what exactly is covered under any given insurance policy. In a perfect world, insurance would be straightforward and simple to comprehend but unfortunately, insurance companies are in the industry to make money and sometimes that works against you. At Doral Dental Specialists, we want to help clear up some common questions that we get asked about dental insurance.
Luckily, you are not alone when it comes to figuring out how dental insurance works, so we hope this helps make a little more sense.
The very first and most important step in understanding dental insurance is evaluating your (and your family, if you have one) dental needs. Thinking about health history, family medical history, oral hygiene habits, income and employer insurance options all come into play when it comes time to make these big decisions.
What You Should Know About Basic Dental Insurance
- Most dental insurance plans offer a basic, low-level coverage that covers preventative and routine maintenance. Regular checkups, cleanings and prevention of tooth and gum diseases are covered under these types of plans. Also, fillings, extractions and maybe a few major treatments may be covered.
- Most likely surgery, dentures, orthodontics or dental implants wouldn’t be covered under these basic coverage plans.
- As the plans and coverage amount increases, most patients will choose plans that offer co-pays and deductibles. Co-pays are fixed out-of-pocket amounts that patients pay for covered services. A deductible is a pre-agreed upon amount of money that patients must pay before the insurance company starts paying for services and treatments. Co-pays count towards a deductible limit.
Common Plan Limitations
- Be aware of plans that require you to wait a certain amount of time between the start of your plan and the time that you require major dental work done such as crowns, bridges, and other dental procedures to be covered by medical insurance. This waiting period allows insurance companies to collect payment before having to potentially payout right away.
- Yearly limits are also something to pay attention to because most coverage plans limit the number of x-rays, fillings, cleanings or other services allowed per year.
Dental Insurance Reimbursement
- This is a predetermined amount of money that the dentists may receive for services performed.
- Patients may also elect for insurance plans that require them to pay for the dental services and submit claims after to be reimbursed from the insurance company.
- Employers may choose these plans to “self-insure” their employees. Patients are allowed to see any dentist they choose and pay for the dental services, then the employer reimburses the employee up to a set limit
PPO vs. HMO
- PPO (Preferred Provider Organization)- dentists that belong to a PPO network are paid on a per-service basis and offer lower fees to their patients.
- HMO (Health Maintenance Organization)- dentists that belong to an HMO are only paid a set fee for their services.
While it is your insurance choice at the end of the day, our staff at Doral Dental Specialists is here to help you understand the details of your coverage, so that you receive the best treatment at the lowest possible cost. This was just a brief overview of some of the basics but if you find that you have more questions like, “can dental implants be covered under dental insurance?” you can call us or stop by our office in Doral to learn more about the help that we provide. To submit your appointment request today, visit Doral Dental Specialists.