“How am I going to pay for this?” This is a common reaction when a dental emergency strikes. At Emergency Dental, we try to help by offering several payment options, even for those without insurance. If you do have dental insurance, you may think you won’t need to worry about cost. The legal nature of insurance contracts make it confusing what is covered and what is not. We have broken it down and have what you need to know about dental insurance here.
What is Dental Insurance?
Dental insurance is a contract that states the insurance company will cover a certain portion of the dental provider’s costs. But like most legal contracts, it can be difficult to understand. It is important to note that medical insurance differs from dental insurance. If you have a medical insurance policy, it will not cover fees from your dentist. In addition, dental insurance functions a little different health insurance. It acts more like a coupon. For example, most dental insurances have an annual maximum of around $1000-1500 per calendar year. To contrast, currently the law prohibits plans from putting annual on most benefits you receive.
Understanding the Acronyms
It is important to note that all dental insurances are not created equal. It is important to know your insurance and what it covers.
- PPO (Preferred Provider Organization)- This means your insurance has contracted with your dentist to pay a discounted fee for services. Generally you can still see other dentists, but just might have to pay a little more.
- HMO (Health Maintenance Organization)- Like PPO’s there is a list of providers to whom the insurance has agreed to pay. But unlike PPO’s, if you see someone who is out of their network, they may not cover anything! Your insurance card should tell you whether your plan is a PPO or an HMO. You can also call the number on your insurance card to find out more information about your particular coverage.
- Dental Discount Plans- Like above, discount plans contract with a certain group of dentists. But unlike them, discount plans don’t pay anything to the dentist for your care.
- Insurances set a UCR (usual, customary, reasonable) for what they will pay for specific dental services in your area. There are some important things to note about these set amounts. UCR’s are created by insurance companies. They are often arbitrary and often do not reflect “average” prices in a location or inflation.
- EOB (Explanation of Benefits)- These pieces of paper that come in the mail describe the deductible, maximums, exceptions and how your insurance has processed your claim. It is important to note that your dentist is not your insurance company. Your dentist gives you an estimate of what the insurance company should cover, not a guarantee. Be your own advocate with your insurance company to receive the you entitled benefits.
Educate yourself about your own care. Be aware of yearly maximums, tooth exclusion clauses, percentage covered on different services, waiting periods associated with your insurance policy before receiving care, and frequency limitations on services. When determining to receive treatment, ask your dentist about other treatment options including difference in cost and longevity to get the most out of the insurance benefits you have.
Don’t forget about the consequences of delaying treatment. Paying for care may seem expensive but neglecting care may cost you time and money in the long run. Remember, at Emergency Dental, we will help you navigate your insurance and figure out other financial arrangements to get the care you need!
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Dr. Roberto Monteagudo is an expert in advanced dentistry, full mouth reconstruction, neuromuscular dentistry and sedation dentistry. He attended the Las Vegas Institute of Advanced Dental Studies from 1999 to 2006 and graduated from Marquette University, School of Dentistry in 1990. Dr. Monteagudo speaks frequently throughout the Wisconsin area on advancements in dentistry and patient education. Dr. Roberto Monteagudo lives in Milwaukee with his lovely wife, Gina, and their seven children whom they make a top priority. He also enjoys outdoor activities and is deeply committed to giving back to his community through charitable events. His warmth and caring combined with his commitment to patient comfort through sedation dentistry, leading edge, gentle, and non-invasive technologies is the reason that his patients travel long distances to see him.