If you have dental insurance and have tried to look over a claim, it feels daunting. Treatment codes, approval codes, denial codes, yearly maximums, and coinsurance calculations can make a dental claim look like something that would stump a professional code breaker.
It seems like dental plans today are covering less and including more fine print, making it hard to know what to expect when you need treatment. Fortunately, our team is experienced in the complex language of insurance and is here to help you determine your benefits and out-of-pocket expenses.
Here are three examples of why dental insurance is so confusing:
Dental Insurance Is Not Like Medical Insurance
Usually when you use your medical insurance, as long as you go within your network, you can expect a fairly straightforward process. You might have a deductible and copay to satisfy, but those details are usually pretty easy to find.
With dental insurance, you probably noticed that different levels of treatment each have a different percent of coverage. We can tell you which level your recommended treatment falls under.
They Might Cover Your Procedure – Or Not
Even if you submit a pre-authorization, the fine print at the bottom of the determination states that it is not a guarantee of coverage. You may wish to contact your insurance company to determine if they require any additional information with your claim to prevent payment delays.
Dental Insurance Promotes Prevention
While not true for every dental plan, many cover preventive services at a high percentage without requiring you to satisfy your deductible. This means you will have minimal out-of-pocket expenses for preventive services such as dental exams, cleanings, and x-rays and will likely need to pay more for fillings, crowns, and implants.
If you would like an Encinitas dentist who will help you understand your dental insurance an give you personalized dental care, we welcome you to contact us to schedule your next dental exam.