Your dentist, after examining a tooth that has been bothering you, tells you that you need a root canal and a crown. The estimate is more than you thought it would be. Will that covered by your dental insurance? How much of it will be covered?
Good questions!
The simple answer is: it depends on your insurance provider. Different companies and different policies all have different limits. It’s important to become familiar with yours and if you don’t understand it, to consult with a member of the HR staff at your company.
A dentist will never recommend treatment based on what your policy says. After all, we can’t be familiar with the details of each of our patient’s plans but we can guarantee that we will always recommend what is best for your oral health.
Basic Realities About Dental Insurance
- It’s a rare policy that covers 100% of treatment, whether preventive or restorative. You are responsible for your treatment costs as your benefit contract with your insurance company is between yourself and them. Most dental offices can help you file your claim, but ultimately, the dentist is not involved in the contract.
- Coverages fluctuate depending on what your company has purchased and many are cutting back what they offer to their employees so be sure you have the most up to date information from your HR department.
- Cosmetic procedures are rarely covered. Again, it’s important for you to know what your policy contains.
- If overall cost is a concern, we can provide your insurance with a treatment plan and cost for approval. This way, you will know what will be covered and what won’t, up front.
- Remember that necessary treatment is not always the same as covered expenses, according to your policy!
Insurance Terms to Know
Deductible – This is an amount that you pay for your treatment before your coverage kicks in. Very often, this is payable annually.
Annual Maximum – This is a dollar value indicated by your company that represents the maximum amount per year / per treatment that they will allow / cover.
Exclusions – This is a list of all the treatments that are not covered.
Co-Payment – This refers to the amount of the treatment that an insurance company will cover (in a percentage format). For example, if you have a 50% co-payment for fillings and other restorative procedures, the company will cover 50% and you will be required to pay the other 50%
Assignment of Benefits – This refers to when a patient instructs their insurance company to pay the dentist directly, rather than the patient paying the whole amount up front and then being reimbursed themselves.
Avoiding necessary care and treatment for fear of the cost puts your health at risk! Talk to us about financing your dental work! If you’re looking for a family dentist, we’d love you to check us out! We have offices in both Milton and Scarborough, both with evening and weekend hours, so give us a call today at our Milton dental office at (905) 636 – 9770 or at our Scarborough dental office at (416) 291 – 0306!
