Your health insurance covers just about everything except your teeth. When it's time to head to the dentist, your health insurance likely turns a blind eye to your ailing chompers, but that's not to say that a trip to the dentist isn't going to take a bite out of your wallet.
Much like your car, it doesn't take much to spend a thousand dollars or more. A crown may cost $1,500, and a root canal might run you $300 to $1,000. Even a simple cleaning will likely come in at more than $100. Dentists aren't cheap and that's why dental insurance coverage may be appropriate for you.
Unless you work for an insurance company, you probably do not spend a lot of your time studying all the terminology that dental insurance companies use to describe the treatments and services they cover. It can be a bit confusing.
Here are some of the most commonly used dental insurance terms and what they mean.
Annual Maximum–The maximum amount your policy will pay per year for dental care. It is often divided into costs per individual, and (if you are on a family plan) per family.
Co-payment– An amount the patient pays at the time of service before receiving care, and before the insurance pays for any portion of the care.
Covered Services– A list of all the treatments, services, and procedures the insurance policy will cover under your contract.
Deductible– A dollar amount that you must pay out of pocket each year before the insurance company will pay for any treatments or procedures.
Diagnostic/Preventive Services– A category of treatments or procedures that most insurance will cover before the deductible which may include services like routine checkups with Bo Davidson, cleanings, X-rays, fluoride treatments, and evaluations.
In-Network and Out-of-Network– A list of providers that are part of an insurance company’s “network”.
If you visit in-network providers, the insurance company will typically cover a larger portion of the cost of the care you receive. If you visit someone who is not part of the network, known as an out-of-network provider, the insurance company may pay for a portion of the care, but you will pay a significantly larger share from your own pocket.
Lifetime Maximum– The maximum amount that a dental insurance plan will pay toward dental care for an individual or family (if you have an applicable family plan).
This is not a per-year maximum, but rather a maximum that can be paid over the entire life of the patient.
Limitations/Exclusions– A list of all the procedures a dental insurance policy does not cover
Coverage may limit the timing or frequency of a specific treatment or procedure (only covering a certain number within a calendar year), or may exclude some treatments entirely. Knowing the limitations and exclusions of a policy is very important.
Member/Insured/Covered Person/Beneficiary/Enrollee– Someone who is eligible to receive benefits under a dental insurance plan.
Provider– Dentist or other oral health specialist who provides treatment.
Waiting Period– A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments; waiting periods may be waived if you were previously enrolled in another dental insurance plan with a different carrier.
There are many different insurance options available, so you need to find out exactly what fits your needs. It’s important to review your plan with a qualified insurance specialist.
AFI will walk you through the process.
Call us today !