3 Keys to Maximize Dental Insurance

 

Dental insurance can be confusing

1) know your policy maximums, inclusions, and exclusions

Every policy has a maximum annual allowance benefit. Lets say it is$1,500 per year. That means the policy will pay out to a maximum of $1,500 per year for dental care. If the policy is a PPO plan, this amount is paid at a rate that is pre-determined through an agreement between the insurance company and the doctor. In other words the fees the doctor charges you and the plan are determined by the insurance company.

 Dental insurance plans are usually  negotiated  between an employer and the insurance company. The employer is trying to get the best plan for a set premium (cost). The premium  of the plan determines what procedures will be covered,  For example a lower premium plan may not cover braces, or dental implants,  or have a lower annual maximum payment. It may also not cover replacement of missing teeth that were lost prior to being insured and so on. The patient may still have the procedures done, but the insurance company will not be helping pay for it.

2) know your anniversary dates and waiting periods

Insurance plans usually reload on January 1, but your plan may have a different anniversary date. Some plans have a waiting period for more costly (major) services.  If there is one and you have a major service done before that date, it will not be paid by insurance.

3) know which providers are in your plan.

Providers will either be in your network of out  of your network.  In network doctors are usually all reimbursed the same for the same procedure. Out of network doctors are paid less and are usually able to charge a higher rate for a procedure as they are not contracted to charge the PPO fee. In our area very few specialists are signed up with any of the PPO plans. If you are referred to a specialist, your PPO plan may not apply.

In addition, there are some HMO type plans in existence, but only a few doctors take them due to the extremely low reimbursement rate.

Call for an appointment 815 459 2292

Dr Neal and his team answers all of your questions regarding your dental insurance and dental health at Crystal Lake Dental Associates.

https://www.crystallakedentalassociates.com

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