By choosing an in-network provider, you get high-quality care at greatly reduced rates.
The best way to take full advantage of your dental coverage is to understand its features. As an in-network provider for major insurance carriers, Precision Dental is happy to work with you and your insurance company to determine your coverage.
The following outline is an overview of how dental coverage works. Precision Dental understands that plan booklets are not easy reads, so we help patients get to straight to what matters most: what’s covered and what are my out-of-pocket costs. You authorize us to make a call to the insurance company on your behalf, we’ll do the rest. You then decide what you want to do.
If you have questions about any of the following aspects of your dental coverage, just ask us to help.
Dental benefits are calculated within a “benefit period”, which is typically for one year but not always a calendar year. Plan benefits which are not used within the benefit period do not carry over. Fall is a good time to review remaining available benefits, if any, for which you have paid. Why not use them? If you need help figuring it out, call Precision Dental.
Most dental plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period (usually January through December). The patient is personally responsible for paying costs above the annual maximum.
Most dental plans have a specific dollar deductible. It works like your car insurance. During a benefit period, you personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Your plan information will describe how your deductible works. Plans do vary on this point. For instance, some dental plans will apply the deductible to diagnostic or preventive treatments, and others will not.
Many insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. What you pay is called the coinsurance, and it is part of your out-of-pocket cost. It is paid even after a deductible is reached.
Many dental plans offer three classes or categories of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.
Here is the way the three levels typically work:
Class I procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 80 percent to 100 percent of the plan’s maximum plan allowance). This is to give patients a financial incentive to seek early or preventive care, because such care can prevent more extensive dental disease or even dental disease itself.
Class II includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example, 70 percent to 100 percent).
Class III is for major services and is usually reimbursed at a lower percentage (for example, 50 percent). Class III may have a waiting period before services are covered.
If your dental care will be extensive, you may ask your dentist to complete and submit a request for a cost estimate, sometimes called a pre-treatment estimate. This will allow you to know in advance what procedures are covered, the amount the benefit plan will pay toward treatment and your financial responsibility. A pre-treatment estimate is not a guarantee of payment. When the services are complete and a claim is received for payment, Delta Dental will calculate payment based on your current eligibility, amount remaining in your annual maximum and any deductible requirements.
Limitations and Exclusions
Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits. These limitations and exclusions are carefully detailed in the plan booklet and warrant your attention, so you have realistic expectations of how your dental plan can work for you.
Specific care and treatment may vary depending on individual need and the benefits covered under your contract.
SOURCE: Delta Dental