One of the biggest reasons people often hesitate to schedule dental appointments is the cost of treatment. Since a regular examination can sometimes range anywhere between $50 to $300, the price is typically a determining factor when seeking care to preserve one’s smile. However, having dental insurance can make all the difference when trying to afford any necessary procedures. But do you often have difficulties understanding your benefits? Read on to learn four tips that can help you navigate your dental benefits!
#1: The Basic Terminology
Here are several basic insurance terms you should be familiar with:
- Benefit period: This refers to the length of time between the “effective date” and “end date” of your coverage.
- Co-payment: The flat fee that a patient is responsible for paying for each appointment or treatment.
- Coinsurance: The percentage that a patient is required to pay once the insurance company has covered their fraction of the cost.
- Waiting period: This is the length of time you’ll have to wait until you’re eligible for coverage. For instance, having a three-month waiting period for root canals means you’ll need to wait until the end of this period to get the coverage for that treatment.
- Deductible: This is the amount you’ll pay out-of-pocket before your insurance can kick in.
#2: “Out of Network’ Isn’t the Same As “Out of Coverage”
Unlike when choosing a primary care physician, a dental team that is “out of network” doesn’t usually mean they’re “out of coverage.” Your dental insurance plan may still be able to cover part of your treatment, but the percentage your company will pay won’t be as high as with a dentist who is in-network. For this reason, you’ll want to consult your dental team about your payment plan before starting any procedures.
#3: Make the Most of “100-80-50” Coverage
Most dental insurance plans are focused on preventive treatments, as the companies expect that you’ll schedule a checkup every six months. That’s why many policies will cover 100% of oral examinations, 80% of minor treatments, and 50% of more intensive procedures. This can be a significant reduction in your out-of-pocket expense, as your routine checkup can be completely covered while a filling that’s $400 can turn into an $80 visit instead!
#4: Feel Free to Ask for Help
If you’re having trouble understanding every detail of your dental insurance, don’t hesitate to contact your dental team for help. By consulting them as well as your insurance company, they can help walk you through your benefits and determine the best way to maximize your coverage. This way you can feel confident about getting the care you need to preserve your smile.
Feel free to reach out to your dentist if you need help or want to know the specifics of your dental insurance. They’ll be more than happy to help make this process much easier for you in the long run!
About the Author
Dr. Jay Patel studied at the University of Texas Health Science Center in San Antonio. He’s also a proud member of several organizations like the American Academy of Orthodontists and the American Dental Association. He offers a wide selection of high-quality services, such as checkups/cleanings and Invisalign, and can help you navigate your dental insurance policy. If you’d like to schedule an appointment, visit our website or call 469-529-6016.