Do you think understanding dental insurance is complicated?

dental insurance

That’s because it is complicated! Dental insurance terms can be tricky to understand, and the explanation of benefits (EOB’s) can be even more confusing. This is why it is crucial to have a base understanding on how your insurance works.

Here at The Smile Lounge in Tigard, we are in network with most major insurance companies and all PPO plans such as:

We also verify every patient’s insurance in our Tigard office before the appointment. However, just because we take the hassle out of verifying insurance does not mean you shouldn’t understand the basics. Failure to understand dental insurance can mean leaving money or benefits on the table! Today, we will discuss 3 important tips to help you navigate the complicated world of dental insurance. 

  1.  Learn The Key Terms 

All insurances from Delta Dental to MODA have the same fundamentals when it comes to benefits. Learning these key terms can make reading the EOB’s easier to read. 

  1. Benefit period- The length of time during which the benefit is paid. This is typically just one year.
  2. Co-payment- A flat fee per visit and does NOT count towards your deductible.
  3. Deductible- The amount you must pay out of pocket before your policy pays for any treatment. Most deductibles are usually $1000-$2000.
  4. Annual maximum- The maximum amount your plan will pay toward the cost of all your dental care within the benefit period. After the maximum has been met, your insurance will not pay for any more procedures or treatments.
  5. Reimbursement level- The percentage coverage your policy will pay per treatment ranging from 100% for preventive to 70-80% for restorative. Anything your insurance does not reimburse is your responsibility to pay to your dentist.

2. Understand The “Exceptions”

Dental insurance comes with all kinds of exceptions, and it’s important to understand them unless you want to get stuck with an unexpected bill! 

  1. Waiting periods- The amount of time you have to wait from your effective date (beginning of benefit period) for type 2 services to be covered. This is basic restorative care like root canals and fillings.
  2. Missing tooth clause- If a tooth was missing prior to your effective date, your insurance will NOT cover to replace it at all. This is similar to “pre-existing conditions” that you will see with medical insurance.
  3. Frequency- Your plan allows certain services at certain intervals. For example, your teeth cleaning is usually covered six months and a day. If you go a day before that six month and a day, your insurance will NOT cover it. This applies to X-rays and bitewings.

3. Use It Or Lose It 

Unfortunately, there are never any roll-overs with insurance. If you do not use all your benefits within the benefit period, they are gone forever. For treatments you do not need, it is barely an afterthought. However, with insurance covering 100% of your routine teeth cleaning, it only makes sense to make the most of your insurance. 

Whether you have Delta Dental, Blue Cross Blue Shield, or Metlife, make the most of your insurance policy, and do not let any benefits go to waste. At The Smile Lounge in Tigard, we take the time to fully verify your insurance to ensure there are no hidden costs, but we encourage you to educate yourself and familiarize yourself with the basics of insurance. If you need dental work, contact us today for a consultation. Our office will break down the coverage for you so you can have an idea of what you have to use toward treatment.

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