We get a lot of questions from our clients about how their dental insurance works. So, we have laid out some helpful points to guide you through the process of using your dental insurance with Bertagnolli Dental.
Your dental insurance plan is going to have a deductible. This means that you will first pay out of pocket for dental procedures, such as a crown or filling, before the insurance coverage and co-pays come into play. Fortunately, insurance rarely applies a deductible to appointments for cleanings or exams.
Annual Maximum Benefit
Based on the calendar year, your Annual Maximum Benefit is generally around $1,000-$1,500, which is how much total dental work your insurance will pay. Once you’ve reached this amount in services, you must wait until the next calendar year to receive additional coverage, unless you pay out of pocket.
Your annual maximum benefit is “spent” on different levels of procedures and typically by a certain percentage. Here’s a quick example:
- Type 1 Services, Preventative Dental Care: Insurance provides 100% coverage for x-rays, exams, cleanings, fluoride treatments, and sealants.
- Type 2 Services, Basic Restorative Dental Care: Insurance pays 80% of the cost for fillings, root canals, periodontal scaling, root planning (deep cleanings), and extractions.
- Type 3 Services, Major Restorative Dental Care: Insurance pays 50% of the cost for bridge work, dentures, crowns, posts, and buildups.
What About Exceptions?
Exceptions are one of the unavoidable basics of dental insurance, so read through you policy to better understand your dental care coverage. You can also call your insurance carrier for clarifications.
If you are just getting new insurance, you may have to wait six months for coverage to begin on Type 2 Services. This is an industry standard, so set your calendars for any basic restorative dental care services including fillings, root canals, periodontal scaling, root planning (deep cleanings), or extractions.
Missing Tooth Clause
If you are looking to get a bridge or implant, hopefully, you still have the tooth or teeth needing help. If the tooth was already missing as you started your new dental insurance coverage, then your insurance will typically not cover the work.
Your dental care group plan only allows services at certain intervals. This includes cleanings only every 6 months. If you schedule a cleaning before the 6 month period is up, your insurance will not cover it. At Bertagnolli Dental, we can advise and set up appointments so you’ll never have to worry!
Be sure that your dentist is contracted with your insurer to ensure coverage. You can also ask for a pre-treatment estimate to be sent over to your insurer. That way, you will see just what they will cover of your dental treatments, so there are no surprises in the bill.
At Bertagnolli Dental, we always work with our clients to get the absolute best benefits coverage and service. We appreciate our patients and want your experience with us to be a pleasant one. Now that you have the basics of dental insurance down, you are ready to schedule your visit with us.