Understanding dental insurance plans can be difficult and we have many patients who rely on our knowledge to help them better understand and utilize them.
Below we will provide you with a bit of information to hopefully help you to understand what your dental plan offers you!
Dental Insurance Plans: THE BASICS
- There are many varieties of different dental insurance plans that offer different coverage options. Many plans offer the standard 100%, 80%, 50% service coverage. This means they will cover 100% of preventative services such as cleanings and exams; 80% of basic services such as fillings; and 50% of major services such as crowns.
- There are many different variations of dental plans that offer different percentages of coverage to you.
- There are 3 basic network types, PPO, Premier, and DHMO(DMO). The PPO and Premier options often times give you more freedom to see which provider you like. They typically offer in and out-of-network benefits. These plans offer the coverage type that I explained above. A DHMO plan limits your network of providers; you are often times assigned a provider and that is the only dental provider you are approved to see. These plans often times have a fixed rate for each service rather than a percentage of coverage.
- Most dental insurance plans work within a “benefit period” that is typically one year — but not necessarily a calendar year.
Dental Insurance Plans: IMPORTANT THINGS TO KNOW
This is the amount you have to pay before your benefit plan begins to pay the cost of your dental treatment.
This is the most money a dental plan will pay for dental care within a benefit period. Once you reach the maximum amount, you will be responsible for paying any costs for the remainder of the benefit period.
If you have a PPO or Premier Plan, known as a fee-for-service, the plan pays a percentage of the treatment cost, and you are responsible for paying the balance.
If you have a DHMO plan, you pay a fixed dollar amount for certain covered services (some services may have no copayment), instead of a percentage.
Limitations and Exclusions:
Dental Insurance Plans are intended to cover part of your dental expenses, so coverage may not extend to your every dental need. A typical plan has limitations such as the number of times you can receive a cleaning each year. In addition, some procedures may not be covered under your plan, which is referred to as an exclusion. In addition, a procedure covered under your plan might be limited or denied based on a clinical.
We understand that dental insurance plans can be hard to understand. If you need help to understand how to maximize your plan, contact Thomas L. Anderson and Associates today at one of our three conveniently located offices in the Kansas City Metro area. We are happy to help you in any way we can!
If you are confused by your dental insurance plan, we are here to help you. Please contact us today to schedule an appointment at the offices of Thomas L. Anderson and Associates. We have three convenient locations within the Kansas City area, including Lee’s Summit / Independence, the Country Club Plaza and Downtown Kansas City. The gentle dentists and expert team at Thomas L. Anderson and Associates look forward to working with you to treat your dental emergency, achieve proper oral health and a beautiful smile that will last a lifetime. If you have any questions about your dental insurance benefits, please do not hesitate to contact us. We are happy to review your policy! Please give us a call today to schedule an appointment and become part of our dental family.