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Knowing Your Insurance Policy

Updated: May 1, 2018

We are well on our way into the new year! A new year signals a lot of different things for a lot of different people. For us, the new year means changes in dental insurance policies for many of our patients.

Raise your hand if your dental plan changed this year!

Okay, now raise your hand if you have no clue if your dental plan changed this year!

Here's the thing, if you felt inclined to raise your hand at that second prompt, you are far from alone! One of the most common statements that we hear patients make is, “I don't know if my insurance will cover that.”

Not to worry, because we are here to help you!

The first thing we do to assist you in keeping track of your insurance benefits is to collect a “Benefit Breakdown” from your insurance company using the information on your insurance card. This report gives us a general overview of what your insurance may or may not cover.

Now, this may come as a shock to you, but your dental insurance company would rather not pay for things. Crazy, right?

To facilitate this, they put all of these fun little treatment restrictions, waiting periods, and age and frequency limitations into your policy. To make things even more confusing, every patient's policy is unique. Unfortunately, there is no grand scale dental benefits system that can tell us in real-time what will be covered. This is especially tricky in the case of a policy's yearly maximum, because if some of your benefits have been used at another provider or a specialist it will not show up in our software. Even with software to aid us, it's impossible to keep track of every single detail in thousands of insurance policies... even though we try our darnedest to do it anyway.

So how do you know what your insurance will cover for necessary care?

The simplest thing that we can do to help you is send a pre-determination request to your insurance company. When we do this your insurance company will review the recommended treatment and let us know what they will cover for that treatment. They will mail back the pre-determination (this usually takes 3-4 weeks) with the coverage estimate and a little clause at the bottom stating that it is only an estimate of coverage and payment can not be guaranteed. How helpful is that?

But, 3-4 weeks?!

What if you can't wait that long?!

The very best thing that you can do to avoid unpleasant surprises when it comes to your dental policy is to know your dental benefit plan. This may seem like a daunting task, especially after everything that was just mentioned, but it doesn't have to be! To make it as easy as possible, we've put together a form with a simple list of questions that you can ask your insurance company. You can find the link to the form at the bottom of this page.

As always, please don't forget that we want to help you! Our first priority will always be to help you achieve a healthy smile, but we understand that sometimes there are limits to how far your dental budget can stretch. In light of that, we also want to help you make the most of your dental benefit plan, and if you have questions about your treatment coverage never hesitate to call or email the office.

-----------------------------Click her for the simple insurance help form----------------------------


Office Manager

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