Now that you have dental insurance you are happy to book a dentist appointment. You have your coverage papers and your insurance card but what does it all mean? Here is a list of things to know about dental insurance that will help you to understand your dental insurance plan. This list is not extensive, so if you have further questions, please contact your dental insurance provider.
1 – Acronyms:
For those of you who have switched dental insurance plans in the past, you may be familiar with acronyms. These acronyms are characterized as PPO, HMO, DMO or DPO. PPO stands for preferred provider organization. HMO stands for health maintenance organization GMO stands for dental maintenance organizations DPO stands for dental plan organization.
2 – Mention Acronym:
Now that you know a little bit about acronyms and what they stand for you will want to schedule an appointment. When you schedule your dental appointment don’t forget to tell them more than the name of the dental insurance company. You have to mention the acronym. The reason for this is because there are different dentists who participate in different kinds of dental plans. If they don’t participate in the dental plan that suits your insurance they can refer you to those who do.
3 – Co-Pay:
Understand that dental insurance has limitations. For people who do not understand dental insurance, they think that the insurance will pay for the whole cost of their treatment. This is not the case at all. Most treatments that are advanced include fillings, crowns, root canals, dentures, extractions, surgeries and more require out-of-pocket expenses. An out-of-pocket expense is called a copay. A co-pay is required in addition to what the dental insurance covers for you.
4 – Coverage Percent:
Do you know what your coverage percent is? A coverage percent is in place to let you know the certain percentage that your dental insurance covers. When in doubt you can always refer back to your dental coverage documents to see what this certain percentage is. An example is 80 or 100% of the cost being covered by preventative care category that includes everything from cleaning, check-ups, sealants, x-rays and fluoride treatments while major treatments like crown, bridges and even dentures are covered for only 50% of the cost.
5 – Deductible:
Most insurance companies will include a yearly deductible. A yearly deductible is the amount that you must pay before your insurance kicks in. This applies to all treatment except for preventative care. Every plan is different so refer back to your insurance to be sure.
6 – Yearly Maximum:
Do you know what your yearly maximum is? A yearly maximum is certain amount of money that the insurance company will pay for your treatment. Once you hit your maximum for the year, you are out of benefits, and you’ll have to pay out-of-pocket for any treatment that is necessary even if it is a small treatment such as cleaning. If you don’t use your yearly maximum for the year it does not and cannot be applied to next year’s yearly maximum. What you may not know is that most dental plans have a yearly maximum that can range from $1,000 to $2500.
7 – Ask Questions:
It is your responsibility to know the details of your dental plan. If you don’t know something or have any questions call your dental carrier, call your dental insurance, or you can go online to get your dental coverage details. It usually includes a list of participating dentists and the group number. Most of the dental offices can assist you with questions about your insurance. Keep in mind they do not know everything about their patient’s insurance coverage. They can only help you with so much, so it is best if you call your insurance company directly if you can.
8 – Get Estimates:
Sometimes if you want to know how much you have to pay for your dental treatment, you can call your dentist office and submit a pretreatment estimate. The pretreatment estimate calculates how much you have to pay for treatment. You can then make your decision or schedule your treatment according to your needs and budget. Sometimes you might have to go through a free consultation, and that’s okay too. You can always ask about financing and costs which is typically included.
9 – Know What Treatments Aren’t Covered:
If you have chosen the correct dental plan that is right for you then you will automatically know what is covered and what is not covered. Treatments that are usually not covered are cosmetic procedures and dental implants. There are some dental plans that are quite limited and only cover exams and cleanings. It’s important to know what treatment you need and if your insurance covers it.
10 – Does Your Dentist Accept Dental Insurance?
As strange as it may seem not all dentist accept dental insurance. If they do, then they probably accept very few. In this case, it means that your out-of-pocket expense will be higher than with a dentist who participates in your dental plan. You may still be able to use your insurance for partial payment at least. If you truly want to know ask the front desk personnel at your dentist’s office to make sure.
For questions about financing and to see which insurances are accepted call 713-322-7474 or fill out the online form and a representative of Omega Dental Specialist will promptly get back to you.