Q1: DEntal insurance can be so confusing. what are Deductibles, Co-Pays and Co-Insurance?
An insurance deductible is the minimum amount that must be paid before the insurance policy pays for anything. For example, if the deductible is $200 and the covered individual’s procedure is $179, the insurance does not kick in and the individual pays the entire amount. Once a deductible is met, most policies only cover a percentage of the remaining costs.
Co-pays, which are a set dollar amount, may also be required at the time of the procedure.
The remaining balance of the bill paid by the patient is called co-insurance, which typically ranges from 20% to 80% of the total bill.
Q2: YOU TOLD ME I OWED ONE AMOUNT, BUT NOW I HAVE A BILL FOR MORE. I THOUGHT MY INSURANCE COMPANY WAS SUPPOSED TO COVER THIS. WHAT HAPPENED?
We do our best to estimate your cost and it’s always our goal to be as accurate as possible about what you owe for your visit. Please remember that we work with many insurance companies and each company has dozens of plans that an employer can purchase for an employee. We encourage all patients to be advocates of their own health. Rest assured that we will do everything in our power to make sure you get the full benefit owed to you by your insurance company.
Here are a few reasons why you may have received a bill:
Your insurance plan paid a lower percentage than expected for the procedure.
The treatment you needed was not covered by your plan.
The insurance company decided you did not need a procedure that the doctor identified as necessary or downgraded a procedure code.
You have not met your deductible.
You have not reached the end of your plan’s waiting period and are ineligible for coverage.
You’ve maxed out your plan (used up all your benefits on other procedures) and no longer have coverage until the plan resets next year.
Q3: THE DENTIST SAYS I NEED A CERTAIN PROCEDURE, BUT IT ISN’T COVERED BY MY INSURANCE. WHY NOT AND ISN’T THERE SOME OTHER PROCEDURE THAT WOULD WORK JUST THE SAME?
The dentist diagnoses and provides treatment based on what you need, not based on what your insurance covers. Some employers or insurance plans exclude coverage for necessary treatment to reduce their cost. If you’re having trouble affording your dental care, ask us! We offer financing options and if the procedure allows, we can sometimes spread out treatment a little to help you afford it.
Have a question that is not answered below? Feel free to give us a call and ask!