KNOW YOUR BENEFITS
Navigating through different insurance plans can get very confusing. We are more than happy to explain all that we can about your dental coverage. The following will cover some of the basics:
MAXIMUMS
Each plan has a set annual maximum which usually ranges from $1000-$2500 depending on your specific plan. The policyholder, spouse, and any dependents on your dental plan will have their own dental benefits to utilize throughout the year. Very often, there are separate maximums for orthodontics and Oral Surgery which will not take away any portion from your other maximum remaining. Some insurance plans have no annual maximums. It’s good to know how much is your annual maximum so you can prepare yourself for any out of pocket costs.
COVERAGE
Your insurance will categorize all procedures. Some of these categories will pay at 100% while others at 80% or 50%. Just know that all procedures, no matter what category, are pulling from your annual max. Once you have hit your maximum for the year be prepared to pay out of pocket. If there’s any leftover amount from your annual maximum, you will lose this amount at the start of each benefit year. Be sure to take advantage of your maximum annually. If you don’t use it, you lose it.
DEDUCTIBLES
A deductible is an amount an individual must pay out of pocket before the dental plan will pick up the subjected dental services. The deductible amount does vary, however, for most dental plans it is $50 for an individual. This deductible renews at the beginning of every benefit year.
IN-NETWORK OR OUT OF NETWORK?
If a provider is considered to be in-network with your insurance plan, the provider has agreed to accept the insurance carrier's approved service fees. At Dyer Dental Care, we are considered in-network with all the major PPO plans. An out-of-network provider can charge more fees as they do not have a contract with that specific insurance carrier.
WAITING PERIOD
Some insurance plans have a waiting period before you can get any major work done. The major work may include deep cleaning, crowns, bridges, partials, dentures, etc.
PREAUTHORIZATION
Since the dental office can only provide an estimate on how much the insurance will pay for a specific procedure, often it is recommended to send out preauthorizations to get a better understanding of insurance coverage and patient portion. It could take 2-4 weeks before we find out the outcome of this preauthorization. There is a lot more to the insurances than described here but it’s a good start. Again, we cannot stress how important it is to understand your benefits. Many insurance cards have contact information, but feel free to call our office with questions. We are happy to help!
At Dyer Dental Care, we accept most PPO dental insurance including (but not limited to) Delta Dental, Aetna, Cigna, Guardian, Principal, Blue Cross Blue Shield, Metlife, Ameritas. Please inquire if you have any specific questions about your insurance plan.
No Insurance? No Problem!- Our in-office VIP wellness savings plan is perfect for those who have terrible insurance or none at all. This plan covers diagnostic and preventative at 100% and other procedures are discounted by 20%. There are no deductibles, no missing tooth clause, no plan limitations, and no yearly maximums. Contact us for more information at 510 487 0311 or learn more about our VIP Wellness Savings Plan
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