Dental insurance is a great help to many families but is not designed to cover all of the costs of providing dental care. Here are a few of the costs built into dental insurance:
Deductibles – Costs that you pay the first time each year you use the plan. They vary from $25 per person to as much as $100 a year.
Copayments – Usually 20% of basic dental care. Generally your insurance will cover 80% of the charges and you will be responsible for the remaining 20%. For more extensive procedures such as crowns or dentures, insurance copayments will be 50% of your total dental bill. Fortunately, there is often 100% coverage for preventive services such as exams, x-rays, fluoride treatments, and simple cleanings.
Some copayments may come as a surprise. For example, if it has been some time since you visited your dentist regularly, you may need care for periodontal disease, instead of a normal cleaning. Periodontal care is usually only covered at 80% while a simple cleaning of a healthy mouth may be covered at 100%.
Schedules of Allowances – These exist for most companies and set an upper limit for the amount the plan will pay for a particular service. This allowance may or may not cover our normal fee. Allowances that are based on usual, customary, and reasonable fees are almost always more than our fees, but allowances based on more arbitrary criteria (such as how much the company has in their dental budget for this particular year) tend to be on the low side. In these cases, our fee may be higher than your companies covered fee and you will be responsible for the difference.
Most companies also have a maximum allowable provision that sets an annual limit on the amount they will pay. This provision limits the annual cost to the insurance company or employer. We are sensitive to this provision and, where possible, will assist you in spreading your optimal care over a period of years to maximize your insurance benefits. Our primary focus will be to eliminate any pain or infection, and then to restore your oral health to it’s best.