Question 1

What's a covered benefit?

Accepted Answer

Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group's plan.

Question 2

What's optional treatment

Accepted Answer

Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.

Question 3

What's the difference between indemnity, PPO, & discount insurance plans?"

Accepted Answer

Indemnity or Traditional Insurance reimburses members or dentists at the dentist's UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without limitations

Question 4

PPO

Accepted Answer

(Preferred Provider Organization) is the most common form of insurance. They provide members with a list of participating dentists. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000 but can be higher or lower depending upon the plan.

Question 5

Understanding Your Dental Insurance

Accepted Answer

We here at Comfort and Care Dentistry want our patients to understand everything about their dental health and what really dental insurance will do or not do for you.  There is a large misconception of what dental insurance is and how to best use it, so here is our attempt at explaining it.    Most medical insurance plans ​do not have a maximum that they will pay per year, and if they do it is usually somewhere ​above $500,000.00 dollars​.   ​All dental insurance plans
​ do have a maximum payment per year and they average around $1000.00. That alone is a huge discrepancy between the two and this number has changed very little since the 1970’s when dental insurance plans began. Which means this ​maximum​ , has not risen in more than​ ​30 years​. This leads to the misconception that your cleanings and x-rays are not part of this maximum. This is because in a medical office when you get your regular check-ups your maximum is so high it doesn’t affect anything. In the dentist office, with a $1000.00 maximum you are only left with $400-$600.00 of benefits after your yearly dental cleanings. This amount is sufficient enough to work on about 1 tooth a year, if anything major is needed.   Here is an example that may help you understand; you come to the dentist and your insurance yearly maximum is a $1000.00, you need a crown on your tooth that had a filling placed in it 15+ years ago, and now the tooth is cracked but not hurting (most dental treatment that is hurting is major and will cost much more than insurance will ever cover, it is much easier and cheaper to fix problems before they are at that point). The Doctor says you need a crown that cost $800.00, but you already had two cleanings that year with x-rays and a couple of small fillings, this took $850.00 of your maximum for the year and now you just have $150.00 left and your part of the crown is now $650.00 and you don’t want it done, or want to wait until next year when you can maximize your insurance benefits. So you wait and then next year the tooth broke even more and the doctor had to rebuild it then using $600.00 of the $1000.00. The doctor also finds a cavity at your first cleaning of the year and fixes it. Now your benefits are gone that year too, you had the crown & build-up, one filling and one cleaning at that was all. Then at the end of the year you want a second cleaning because your insurance said you get two per year, but here are the hard cold facts: your benefits are gone and if you want the cleaning the insurance will not pay for it.   Too many people we see will choose not to come in until next year for their check-up and their teeth worsen due to maximums. I know it is hard to understand, but the only way not to get a cavity is to stop eating, there is the lucky person here and there that have never had a cavity, but for the rest of us it does and will continue to happen. Just think about what you do at least 3 times every day and for most of us this is “EAT”. You are using your teeth constantly and they will wear down just like the tires on a car. We hope this helps you better understand your dental insurance or should I say your dental insurance “preventative” coverage

Call us at today
(704)748-1110

Insurance

Insurance FAQ

Call us at today (704)748-1110

Insurance

Insurance FAQ

Call us at today
(704)748-1110