Dental Insurance 101

In this blog I would like to explain the basics of dental insurance. Dental Insurance benefits are confusing, some days even to us. We want you to understand your plan well so there is one less thing to worry about when you are in our office.

There are many Dental Insurance companies, primarily Delta Dental, Aetna Dental, Cigna, Guardian, MetLife, United Concordia, BCBS etc. Your Employer negotiates with the Insurance company on the benefits they want you to have. If you feel like your plan is not to your satisfaction you should approach your HR about switching plans if possible.The first thing you need to know about your plan is whether it is a HMO/DMO plan, a PPO plan or a state run plan like Medicaid, Smiles for Children etc. If you have a HMO/DMO plan or a Medicaid or Smiles for Children type of plan you will have to go to an office that is contracted to provide care for patients with this insurance. You will not be able to utilize Dental Insurance benefits from these plans if you choose to go to a non participating provider. In general you will find it harder to find offices that accept these insurance plans.

It is a lot easier to find providers who accept PPO plans and so, you have a greater choice in choosing your provider. Most Dental Offices that accept PPO insurances are either “In Network” “Preferred Providers” or “Out of Network” providers. “In Network” offices are contracted with your Insurance Companies to provide you with treatment at lower reimbursement rates. This reduces the cost for treatment that you have to pay out of pocket. You can use your PPO plans at offices that are not in network. These offices will file for your benefits or help you file for your benefits, but your out of pocket treatment costs might be higher, typically 20% or more. If affordability is your main concern on how you choose a Dental Office, then simply ask if the office is in network or out of network with your Dental Insurance. Out of Network offices might mean higher out of pocket treatment costs for certain procedures.

To find a Dentist near you who accepts your PPO Plan use the links on this page. Just click on the name of your Insurance company and it will take you to the relevant page. Once you choose a Dentist near you who accepts your particular Insurance, these are the things you need to be aware of regarding your plan. Unlike most Medical Plans, most dental plans do not require you to pay an office visit co pay. If you have to go to the Dental Office multiple times you are not required to pay an office visit for each visit.
Most services that you get at a Dental Office are divided into three tiers, called Preventive, Basic and Major. Preventive services are typically your check ups, needed x rays or radiographs and simple cleanings etc. Most Insurances pay the entire cost for these services and you should not be required to pay anything out of pocket. Other services such as Deep Cleanings (Scaling or Root Planing), Fillings and Extractions will be typically included under the Basic category and will be covered anywhere between 50-90% depending on the benefits your employer wanted you to have. Most Insurances will only pay a portion for these services and patients will have some out of pocket expense for Fillings, Deep Cleanings or Extractions. Other times, your “White” or Composite Restorations are not covered but your insurance company will only pay for a “Silver” or Amalgam Filling. This means that you will end up paying more for Composite restorations. These things are in the fine print of your insurance contract and it is best to budget for a bit more when you plan on getting this kind of work done.

Major Services are typically covered at 50%. Root Canal Treatment, Wisdom Teeth Removal, Orthodontic or Braces Treatment, Crowns and Bridges, Dentures are all typically considered as a “Major” category. Insurances will pay a smaller portion for these services and you will be required to pay at least half the cost for the treatment.
These services can be expensive and since there might be clauses in your insurance company contract that do not exclude these benefits, it might be beneficial to have a predetermination to see what the coverage is, before treatment is initiated.
With all this said, please do not choose your provider on the basis of whether they are on your plan or not. You should not entrust your Oral Health in a provider you are not comfortable with. Quality and Comfort are the first reason to go to see your Dentist!

So, I know this was rather boring. My hope is that you understand your insurance a little better and can plan your Dental Budget better! If you need a Cosmetic Dentist, a Family Dentist or a Dentist for your Children who takes your insurance near Cumming, GA (30028, 30041, 30040) / Canton, GA/ Suwanee, GA (30024) / Alpharetta , GA(30004, 30005)/ Johns Creek, GA (30004, 30005)/ Buford, GA or Dahlonega, GA, call my office at (678) 922-8282 or click here to schedule your appointment.

You can use the following links  to see who are some of the dental providers near you!

Delta Dental
Cigna
Metlife or MetDental
Anthem
Smiles for Children
Anthem HealthKeepers
Aetna
Guardian
United Concordia

Leave a Reply

Your email address will not be published. Required fields are marked *