Insurance Simplified

Before working with insurance on a daily basis I felt like insurance companies spoke a foreign language.  I would get my benefit summary in the mail, flip through the pages (if even that) & file it with all my other things I was supposed to keep, but never looked at.  Now that I do work with insurance every day… I still do the same thing, but it has started to make a little more sense to me.

Basically, dental insurance consists of a deductible, coinsurance, and maximum. However, even once you understand these concepts, insurance throws a few curve balls with waiting periods, frequency limitations, age limitations, and exclusions.  It can be mind boggling.

So, here are some important things to know about your dental policy.

  1.  USE YOUR PREVENTATIVE BENEFITS.  Go to the dentist.  Regular exams and cleanings are the best way to keep your teeth healthy so you don’t have to have more invasive and more expensive procedures done. MOST (not all) dental insurance policies cover routine cleanings, exams, and x-rays at or close to 100%.  Prevention is key.  It is a waste of your money to pay for a dental policy and not take advantage of these benefits.
  2. MAXIMUM BENEFITS.  Most insurance policies have a benefit maximum.  Once the insurance company pays this amount they will not pay a dime more.  That means anything over this set amount comes out of the patient pocket.  There are no exceptions to this rule.
  3. WAITING PERIODS.  This seems to be the trickiest part of dental policies to me.  Some companies are very open about waiting periods and others seem like they try to hide it.  I seem to miss even the ones that are right in front of me.  I wish they were in bold print with flashing neon lights – still can’t guarantee that I would catch it.  If a procedure falls within a waiting period you have zero coverage.  Even if your policy says crowns are covered at 50% if it is within a waiting period they will not pay.  The patient pays 100% of the charges.  Again, no exceptions.

There are thousands, if not millions, of different dental policies available.  It is impossible to know every detail of every policy.  Call your dentist and get scheduled for a cleaning.  Keep up on regular visits, and follow through with recommended treatment sooner rather than later.  Don’t be afraid to ask questions, and if you don’t understand ask again.  Be your own advocate.  Insurance is a contract between the insurance company and the patient.  Don’t be afraid to question their payment or lack of.  A patient always has the option to appeal any insurance decision and I have learned that insurance companies, like all of us, can and do make mistakes.

Written by: Karen Marintzer

Cedar Lodge Dental

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