Use Your 2015 Dental Benefits Before They are Gone All dental plans limit their benefits to a certain dollar amount, typically anywhere from $1,000 to $2,500 annually per each member of the family. If the benefits are not used by the end of the year, they are eliminated, and the new plan starts at the beginning of the following year. The unused portion of the policy does not carry over to the next year. We recommend you contact our office to ensure you use all your remaining 2016 benefits. When creating a treatment plan along with your dentist, it is recommended to submit pre-treatment requests for all proposed procedures prior beginning any dental therapy. It allows you to fully view what the scope of your financial obligations will be and plan accordingly. As the pre-approval process typically takes 30-60 days, planning is the best method to take advantage of the full dental coverage without allowing the benefits to expire at the end of the calendar year.
Dental Insurance Coverage The most effective way to use any dental benefits coverage is to become familiar with the terms and conditions of the policy. Many insurance companies offer different plans with a variety of features, and they are typically calculated for a period of one year, but not always a calendar year. Special attention should be focused on any clauses and exceptions to ensure that the benefits are used wisely throughout the year.
Deductibles Every dental insurance covers a certain portion of the cost for the procedure and carries the deductible payable by the patient. Depending on the policy, the deductible amount can vary from 20 to 50%. The insurance provider pays the charges submitted by the dentist according to the following classification system:
Class I -Preventive care, such as routine exams, x-rays, sealants and prophylactic cleanings, are typically covered 100 percent and are almost always allowed by all insurance companies. Class II -Simple restorative dentistry, such as fillings is generally covered at 80 percent by the insurer. Class III – Extensive procedures, such as root canals, crowns, complex extractions and involved periodontal treatment may be covered at 50 percent. Pre-authorization may be needed for this type of procedures and waiting time may be involved before the treatment can be implemented. Cosmetic dentistry, such as tooth whitening, implants or porcelain veneers, is almost never covered as it is considered not medically necessary.
Co-insurance Provisions Some of the dental insurers implement this type of provision instead of the annual maximum. The company pays a certain percentage of the cost while the patient pays the rest of the charges out-ofpocket. However, there is no annual limit, and the patients can complete their treatment providing they can meet their financial obligations to the treating dental provider.
Limitations Every dental policy has its limitations and exclusions. As they widely vary for each provider, most of them include the following: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Age limits Number of visits per year Number of cleanings per year Nutritional advice Behavioral management Limited number of restorations. For example, anterior teeth can be restored with tooth-colored fillings, while the posterior teeth can only be restored with amalgam fillings. Crowns may be covered for anterior teeth only. Porcelain bridges may not be covered, but missing teeth can be replaced with removable appliances such flippers or partial dentures. Implants are excluded from treatment. Tooth whitening is not covered and must be paid out-of-pocket.