FAQ About Dental Insurance:
ANNUAL MAXIMUM: This is the TOTAL amount that your insurance policy will pay for all treatment in a given period of time. Usually it is within a calendar year, but there are some plans that are on a benefits year which is determined by your group policy.
DEDUCTIBLE:It is an annual figure that you must pay before insurance pays for any treatment (can range from $25 to $100) and it usually applies only to restorative (fillings, extractions, root canals) and to major (crowns, bridges, dentures) treatment.
COMPOSITE FILLINGS: Composite fillings, also known as tooth-colored fillings, are usually paid by most insurance companies at a downgraded amount. Insurance payments are usually based on the insurance company's allowed fee for an amalgam (silver) filling. Therefore, your portion for composite fillings will include your co-payment (usually 20%) plus the difference between the insurance allowable for an amalgam filling and our cost for the composite filling.
MISSING TOOTH CLAUSE: Some insurance policies have a clause that states that if a tooth was lost prior to your current coverage with them, there will be no benefits paid toward replacing that tooth and the entire cost would be the patient’s responsibility.
WAITING PERIOD: Some insurance policies have a clause that states that an insured must have active coverage for a set period of time, prior to being eligible for benefits for certain services. Typically it is a 6 or 12 month waiting period for major services, but it can apply to other services as well.
PREFERRED PROVIDER (PPO): A PPO is a dentist that signs a contract with an insurance company to charge specific fees for covered dental services and write-off the difference of the dentist’s fees and the allowed amount.
OUT OF NETWORK PROVIDER: Is a dental provider that is not contracted with your dental carrier. With most plans you can see an out of network provider, but you will be responsible if there is any difference between what the dentist’s charges are and what your insurance allowable is.
