What you need to know when it comes to the coverage of your dental care
Article Courtesy of SoundBridge Dental Arts and Sleep Therapy
Here at SoundBridge Center for Dental Arts and Dental Sleep Apnea Therapy, we want our patients to be keenly aware of their insurance benefits. Insurance is an important factor in our patients’ care. In our practice, we utilize dental insurance if you are having any type of dental treatment completed by Dr. Bloomquist and medical insurance if you are seeing Dr. Iregui for an oral sleep apnea appliance. In this two-part series, we address some of the most common insurance-related questions we are asked—and the answers.
How are insurances chosen through my employer?
Companies select which insurance to utilize based on what the premiums are and the benefits inclusive to that plan. Due to harsh economic times and rising health-care costs, it has become increasingly difficult for employers to pay premiums for the best available coverage for their employees. Therefore, oftentimes, the plan selected by your employer has limited coverage.
What does being an “in-network” provider mean?
Being an “in-network” provider means that your dental office has agreed to a significantly reduced fee schedule in order to participate with your insurance company. While it does benefit you as a patient as far as what your out-of-pocket costs are with your provider, it also means that your provider isn’t being reimbursed for the true value of their work. Quality over quantity.
Do insurances dictate what is covered?
Insurance companies write policies and include a lot of fine print that helps them contain their own costs, rather than maximizing the benefits for you, the patient. Let’s say your hygienist recommends three cleanings per year rather than two; however, your insurance will only cover two per year. Are you going to go with your hygienist’s recommendation, or are you going to allow your insurance to dictate your health-care needs? Most commonly we see patients select the latter option, and it leads to increased needs down the road.
Why aren’t certain services a covered benefit on my plan?
We hear this question a lot. Insurance companies do not offer coverage for what they deem to be elective services; items such as tooth whitening, restorations for cosmetic purposes, nitrous oxide, and even bite guards and sports guards. Regardless of the money that you and/or your employer contribute to the plan, insurance companies have their own limitations, so it is important before agreeing to an insurance plan that you do your research and read through the fine print of the contract.
What if I don’t have dental insurance?
This is exciting news! Unless you have an employer that is paying for your dental insurance, it often isn’t worth the expense of monthly premiums, plus deductibles and copays for your own individual dental insurance plan. We’ve found that some of our patients were paying more annually for their dental insurance than they would have been for routine care out of pocket! This inspired us to offer an in-office program for patients without dental insurance as a way to help offset costs for keeping up on their regular care. Just call our team and ask about our Wellness Program!
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