For many patients, dental insurance can be tricky to understand. The verbiage used and the breakdown of benefits can often make anyone frustrated, but there’s help! Most dental practices have an expert to assist patients, answering questions and dealing with concerns on the financial side of dentistry. But you don’t have to start with them from scratch. Here is an explanation of how coverage breakdown works for most insurance companies.
Preventive and Restorative Care: What Dental Insurance Will Cover
A traditional dental insurance policy usually has two columns: one for in-network and another for out-of-network. Understanding this distinction is important, and so is knowing the percentage breakdown for services, which usually fall into two categories: preventive and restorative care.
Most dental insurance policies cover preventive services at 100% because the company wants to minimize dental issues and encourage patients to be proactive in caring for their smile. General exams, cleanings, dental X-rays, and fluoride treatment are all considered preventive and are included in these benefits.
Sudden injuries and problems can pop up even when you least expect them, which is why dental insurance companies will pay anywhere from 50 to 80% of the total cost for minor and major restorative services, including fillings, dental crowns and bridges, root canals, tooth extractions, and periodontal therapy.
An important concept to understand is that the amount an insurer will agree to pay may be decided based on whether you have met your deductible and how much is left in your annual maximum. For example, if you required additional restorative services early in the year and now need a root canal, you may not have enough money in the yearly maximum for your insurance provider to pay the full 50% of the total bill. However, even if the company only pays 30 or 40%, it still spares you from having to pay the entire bill on your own.
What Will Dental Insurance Not Cover?
If you are hoping to improve your appearance through cosmetic dentistry, you may be disappointed to know that these services are not covered by dental insurance. Unlike dental crowns and fillings, which are necessary to restore oral health and function, cosmetic solutions are considered elective. Veneers, teeth whitening, and other similar services do not provide the same urgency as restorative solutions.
As a result, the patient is obligated to pay for cosmetic dental treatments. Many times, paying upfront isn’t feasible, but most dental offices an in-house membership plan or accept payment through flexible financing.
Armed with this general knowledge, you can meet with your dentist and discuss upcoming treatment. A member of their dental team can review your policy and explain which services are covered and which are not. This information will help you determine how best to move forward when for your oral health.
About Grand Dental – Franklin Park
With a team of skilled dental specialists, Grand Dental – Franklin Park is staffed with professionals who care about patients and their ability to afford high-quality dentistry. We can offer advice and identify ways to maximize benefits and minimize out-of-pocket costs. If you would like to learn more about what you can expect to be covered, visit our website or call 847-455-8383.