What do my Health Insurance Benefits Include?

A lot of people who have dental insurance don’t know much about their coverage. They just go to their dental appointments expecting their office to know what is covered and just tell them their portion. Most offices are happy to offer this service to their patients for convenience. There may be some situations where you might want to know a few dental terms. Perhaps you’re shopping around for insurance, this list will help you with what you need to look for to best suit your needs.

Yearly maximum: This is pretty self explanatory. This is the maximum amount your insurance will pay toward your dental work for your dental year.

Most insurance companies run off a calendar year January-December but some will run on a contracted year. If it’s a contracted year they will specify which month it starts and ends in. ie: July-June or April-March.

Deductible : There will usually be an individual deductible of $25-75 and a family deductible of $75-225. Your insurance will start paying for dental work after you’ve covered the deductible amount after the first part of your insurance year.

Family deductible: Typically, the deductible applies to up to 3 people in the family. Once it’s been met for the year for those 3, you do not have a deductible for any remaining members on the plan. Verify this with your insurance carrier.

Waiting period: If you are getting insurance because you were just seen at the dentist and have a major treatment plan and you want a little help with paying, you’ll want to ask about a waiting period. Some insurance will have a 6 month waiting period on basic procedures and/or a 12 month waiting period for major procedures. This means they will not pay anything on that treatment for 6-12 months from your effective date, and until then, you are only covered for preventative treatment.

Missing tooth clause: A few insurance companies have a missing tooth clause in place. This typically means if you have a tooth that was missing before you accrued the insurance plan, they will not pay for any treatment to replace it. This will generally include partials, bridges, or implants.

Coinsurance: Coinsurance is when you have an insurance plan that will pay a percentage of a procedure, leaving you with the remaining percentage and a portion. A common rate is 80% coverage on fillings, which leaves you, the patient, with a 20% portion.

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If something comes up that you have questions or concerns about, your dental office or insurance customer service line should be able and willing to assist in answering them for you. Our dental office answers calls 24/7 if you have questions about the insurances we accept. Please call 801. 806. 4645

Dr. Chavez, a dentist in Provo, and his staff answer lots of patient questions about insurance. It can be confusing! But taking care of your teeth and taking advantage of your benefits is a win-win. To schedule an appointment with the best dentist in Provo, call 801-426-6255