Check your dental insurance plan beforehand: a few tips
Insurance of any kind can be difficult to understand, including the dental coverage. At Downtown Dental Centre, we strive to help you understand your dental insurance coverage, so you can use it to improve and maintain your oral health. As everyone’s insurance plan is unique, it is critical that you have a look at your policy and provide both the group and member identification numbers. We are not able to have a look at your policy online due to privacy regulations, but you are able to share that information with us if you choose to do so.
It is always better to know about your basic dental coverage
When patients join our practice, one of the first questions they ask is “Will this appointment be covered by my insurance?” Again, we’d love to provide a definitive answer, but due to privacy regulations and the uniqueness of everyone’s policy, we cannot make any guarantees of coverage. For that first appointment it is best for you to call your provider and inquire about basic dental coverage (exam and x-rays). Once we have seen you for an exam and have your insurance information, we are able to send an estimate away to your provider so that you are aware of your dental benefits for any future treatment.
One common misunderstanding about dental insurance coverage surrounds dental hygiene appointments.
Hygiene appointments are billed under units of scaling. One unit is 15 minutes of time. Scaling includes reviewing your chart and updating your medical history, as well as oral cancer screening, periodontal probing (health of your gums) and of course, removing calculus from your teeth. Insurance plans will provide a set amount of units per year, and those units can be used at any time throughout your plan year. Patients are often confused about this aspect, as it may appear on your plan that you are covered only once per year. For the majority of plans your exam and x-rays are covered every 9-12 months, but the units of scaling are able to be used whenever needed throughout your plan year.
Questions to ask of your dental insurance provider:
- How often am I eligible for an exam? If you are new to our practice, are you covered for a new patient exam?
- How often will they cover the cost of x-rays? There are 3 kinds: bitewings, PA’s, and panoramic.
- How many units of scaling do I have per year?
- How often is a polish and fluoride covered?
- Do I have a yearly plan maximum?
- What is my insurance year? Not everyone is a calendar year (Jan-Dec).
- Optional: Do I have orthodontic coverage? Is there a maximum?
- Optional: Do I have coverage for major work such as crown and bridge work?
Remember that insurance plans are there to help you with the cost of your treatment, but may not cover the entire cost of everything needed for your best oral health.
At Downtown Dental Centre, we work with you to find the best solution for your health. Occasionally you may need to spend some out of pocket expenditures. We will always ensure that we provide and explain all of your options, and investigate how your insurance can best help attain your goals. We offer direct billing to your insurance provider, so you are responsible only for the difference in fees. It is both your responsibility to understand what insurance is offering to pay, and what part you will be held accountable for. If you have questions, bring them in; we have excellent staff who are ready to help!
