Understanding Dental Insurance

At Smile Dental Partners, our Treatment Coordinators specialize in helping you reach your goals by estimating any investment you may have in your treatment.  We reduce surprises in your portion of payment by using the most comprehensive dental insurance software available to keep your insurance information up to date and creating financial treatment plans.

Insurance has become more complicated in recent years, and dental insurance is no exception.  There are thousands of different dental plans, and each policy has distinct benefits and rules of coverage that were determined by both the insurance company and your employer.

Policies can change your benefits and rules of coverage at any time.  Insurance companies do not notify dental offices of your changes.  While we attempt update our information about your policies on an annual basis, we may only become aware of changes upon filing a claim on your behalf or if you tell us of any changes to your coverage.

By understanding your own insurance, we can work as a team with you to provide the most accurate financial estimates.  Below is some insurance “lingo” that may help you understand your coverage:

Participating vs. Accepting:  This confuses most people.  If you call a dental office and ask is they “accept” your insurance, you are actually asking if they will bill your insurance company for you.  And the answer is almost always yes.  What you probably really want to know is if the dental office “participates” with your insurance?  This means that you will receive a discount for services covered by your plan, or the dentist office will “write off” a portion of the fee when applicable. Click here for our participating insurance companies.

Covered Services:    At what percentage are your cleanings, exams, fluorides, x-rays covered?  How often will the insurance pay for these services? Are there waiting periods before they will pay for your treatment?

Deductible:    This is an annual amount you are responsible for before insurance coverage begins.

Co-Payment: The percent split between insurance payment and your responsibility.

Pre-determination:   Some insurance requires permission for a procedure prior to receiving the service.  If these services are provided without pre-determination, the payment for services may be denied.  Pre-determination does NOT guarantee payment of your claim.

 

Benefit Limit:   An annual (for lifetime) limit that an insurance company will pay for your care.

 

Primary Insurance:   if you have more than one insurance policy covering you, the primary insurance is required to consider the claim for payment first.  For children whose parents both have insurance contracts, the primary insurance is determined by the month of each parent’s birthday (typically).

 

Secondary Insurance: A second insurance contract.  The secondary insurance contract may or may not cover costs that the primary insurance contract does not pay.