Dental Insurance Information

There is a difference and it is important to know. Accepting your insurance and being “in-network” are not necessarily the same thing.

An “in-network” dentist has contracted with your insurance company to accept discounted rates. Usually, you will pay less with an “in-network” dentist. “Out-of-network” dentists have not agreed to the discounted rates.

Here is an example:
Let’s say you go to a dentist that is in-network and the total charge is $250. A discount is then applied to that amount for the negotiated rate with the dentist. The discount is $75. The insurance company would then pay $140. You would be responsible for the rest, which is $35.

If you go to a dentist that is out-of-network, there would be no discount applied to the total charge. Your insurance company would still pay $140 but you would have to pay the rest, which is $110.

When a dental offices says that they “take’ your insurance, that means they will file a claim on your behalf with your insurance company. If they are not “in-network”, with that company, they are not tied to the fees dictated by them and can charge what they want. And then, whatever is not covered by the insurance, you pay.

The best way to check is to see if a dentist is in-network is to call the customer service number on your insurance card and verify that dentist’s network status.

As in other types of insurance, dental insurance has deductibles. This is the minimum amount that must be paid before the insurance policy kicks in and pays. For example, if the deductible is $250 and your procedure is $200, you would pay the entire amount.

But once the deductible amount is reached, the insurance will begin paying, but they only pay a percentage. You will still have to pay what is called “co-insurance,” which is usually 20-30%, depending on the procedure. (See below for a financing option).

Dental policies have maximums, which is the max the plan will pay for dental care within a benefit period, which is typically a year.
They usually from $750 to $2,000, with $100 being very common. Often the higher the monthly premium you pay, the higher your yearly maximum will be.

Once you maximum is reached, you will have to pay 100% of any remaining dental procedures.

Some dental insurance policies roll over a portion of the unused annual maximum to the next year.

A maximum of $1000 or so does not sound like a lot. However, research has shown that 93% of the time, this annual max was enough to cover most patent’s dental needs for the year.

At Family and Implant Dentistry of Colorado, we can help you work with your maximum. Once we become familiar with your plan, it is our job to help you manage your benefits. For example, if you see one of our dentists near the end of the year and she recommends that you get two fillings, but your plan will only cover one before the maximum would be met, we would then help you schedule the other one in January (assuming it can wait.)

Dental insurance companies put waiting periods in place to discourage people from obtaining dental insurance right before they need a lot of dental work. While there are plans with no waiting periods, most dental insurance policies have 6-12 month waiting periods for most standard dental work. For major procedures, it can be longer.

It’s very likely that it will. Most dental insurance plans cover 100% pf preventative care, like annual or twice yearly visits for cleanings, X-rays and sealants.

Basic procedures such as fillings, tooth extractions, root canal and some treatments for gum disease are usually covered 70% to 80% by insurance, with the patient paying the remainder.

For major procedures like crowns, dentures, and bridges, often the patient will pay a larger percentage. But every plan is different, so it is a good idea to take a look at how your plan covers different procedures.

Cosmetic procedures are not typically considered medically necessary for your health. These are things like teeth whitening, veneers, and gum contouring. Most dental insurance policies will not cover these, and so the cost is paid by the patient.

But that is why we have our Dental Advantage Plan, which is a discount plan you buy with a yearly membership fee, and it gives you discounts on all of the dental procedures you have throughout the year – including cosmetic procedures!

We know that dental insurance plans can be incredibly confusing for our patients Sometimes they are even for us and we deal with them on a daily basis!

Contact Us Today to find out if we are In Network with your Insurance company. And when you come in, we will be happy to take the time to walk you through any question your may have on your coverage and what your costs will be.