Will My Insurance Cover This?
“Will my insurance cover this?” It’s one of the most common and important questions we hear. We understand that dental insurance can be confusing, and we believe you deserve clear, straightforward information to make the best decisions for your health and your budget.
Understanding Your Dental Insurance
Dental insurance does not typically function in the same way as health insurance. A more appropriate term for the product is a “dental benefit plan.”
Oftentimes, after a required deductible is met for that year, the plan will cover a certain percentage of allowed procedures up to a yearly maximum. The rate at which the insurance company covers a procedure is an agreement between you (or your employer) and the insurance company.
While we are happy to file any necessary forms for preauthorizations and completed procedures, we cannot (and the insurance company will not) guarantee coverage. We strongly suggest that you become knowledgeable about your plan prior to having any treatment.
Key Parts of Your Plan
Understanding the standard terms in your policy is the first step:
- Deductible: This is the amount you must pay out-of-pocket each year before your insurance begins to contribute to your care. For example, if your deductible is $50, you pay for the first $50 of treatment yourself each calendar year.
- Coinsurance: This is the percentage of the cost of a procedure you are responsible for after your deductible is met. A common plan split for example is 80/20, meaning the insurance plan pays 80% and you pay the remaining 20% for basic procedures like fillings. For major procedures like crowns, the split might be different, closer to a 50/50 split in your plan.
- Annual Maximum: This is the total amount your insurance will pay out within a full benefit year. Once this limit is reached, you are responsible for 100% of any additional costs until the plan renews. Knowing this number is essential, as it directly impacts your treatment plan.
- Preventive Care: Most plans cover 100% of routine preventive care, like exams and cleanings, because insurance companies know it saves them money by avoiding more complex procedures later.
Our Role as Your Dental Care Provider
We will always recommend treatment based on what is clinically best for you. However, if you have questions about your specific insurance plan, don’t hesitate to ask! Call us at (573) 449-2311, and we’ll gladly review your coverage with you.