Dental insurance plans are among the most widespread sectors across the United States, filled with complicated policies, variances in services, and sometimes expensive costs. From Medicaid dental coverage to companies like Humana Dental, patients continuously search for the benefits that will serve them best and understand what their plans mean in terms of payments. The insurance market expands greatly across giant private organizations and federal institutions, so knowing how insurance works are vital towards getting the best health care possible. Dental plans, however, work somewhat differently, and today, we’ll be going over the basics of dental insurance.
The Terminology of Dental Insurance
Each person’s benefits will differ from the next person. By attaining information surrounding your coverage, you can be better prepared for what you’ll pay, what your dentist will bill you, what treatments you can afford, and what your insurance will cover. One note to take in about dental insurance is that your insurance does not determine your treatments – if you work with an excellent dentist, they’ll be able to help reduce the costs of any treatments you need by creating a predetermination, or a pre-treatment plan, to submit to your insurance company to help assess for the costs and coverage. By gaining a predetermination, you should receive the following information about your coverage:
- Your specific treatment plan will include what treatments you dental insurance covers and the exceptions that are excluded and/or paid out-of-pocket.
- An accurate estimate will consist of the total costs that your insurance will cover and what you pay for treatment.
Throughout this explanation, your insurance company will also use terminology such as maximums, deductibles, and reimbursements, as part of the insurance process. To best read this information, it’s also essential to know what these terms mean and how they affect your relationship with your dentist. Specific terminology used often in insurance takes on a whole new meaning for patients receiving the dental care they need. These terms include:
- Deductibles: Deductibles pay the insurance company before treatment. Deductibles work to reduce the amount you need to pay for co-payments. These payments also allow dentists to submit claims to reduce treatment costs.
- Maximums: Maximums indicate the monetary limit that your dental insurance will allow for treatments. Once your dental plan reaches that maximum limit, patients will need to pay out-of-pocket for the remaining balance.
- Dual Coverage: If you have more than one coverage plan to cover multiple kinds of treatments, then your primary plan will pay for your treatment, and the secondary will act as a cover for other procedures. Together, these plans cannot exceed 100% of the payments made for your treatment, and the secondary plan will act as a backup for some out-of-pocket expenses.
Reimbursements: In other cases where a patient has a fee-for-service plan, the plan will use repayments as a way to cover costs for treatment instead of deductibles. Reimbursements work by first paying for the treatment out of pocket. The insurance will cover a certain percentage of treatment costs once the repayment is sent to the insurance company, and then will take that money and reimburse the remaining balance back to the patient.
Many aspects of dental insurance revolve around understanding basic concepts, and by understanding these terms, they’ll work positively in your favor when receiving dental treatment. For more information about how practices handle different dental insurance types, schedule an appointment at Waco Dental, operated by Dr. Alan Martin in Waco, TX.