The coverage provided by dental insurance varies widely between plans. In most cases, your employer will offer one or more plans. The contract established between your employer and insurance provider determines the type of coverage available to you. Dental insurance can be incredibly complex. Figuring out what your insurance plan actually covers can seem overwhelming and is often frustrating, but most dental offices are happy to help you fully understand your coverage.
There are many providers of dental insurance, all of which offer different levels of coverage. Some of the dental insurance plans on the market include:
By purchasing a dental insurance plan, you enter into a contract with the company. They agree to pay certain amounts for certain procedures and you assume responsibility for what they do not cover. Generally, the terms of your coverage are spelled out in the contract. Different plans approach coverage in different ways. Some require you to reach a deductible before paying anything, while others pay a percentage immediately. Understanding the different terms associated with your insurance plan can help you figure out your coverage.
A deductible is a minimum amount of money you need to pay towards dental care before your plan coverage starts.
If your plan has a LEAT clause, the company will only pay for the least expensive treatment available for any given condition.
Many plans have a cap on how much money they will pay for any given treatment during the year. Anything over that amount becomes your responsibility. For example, if your plan has a annual maximum of $2,000 and your dental expenses exceed $3,000, you have to pay the additional $1,000. In some cases, you can raise your annual maximum to better suit your needs. There is usually a separate lifetime maximum for orthodontics.
Some plans have limitations on how often they will cover a certain procedure. Generally, there is a set number of procedures permitted in a specific period. For example, most dental insurance plans will only cover two professional cleanings every 12 months, or one cleaning every six months.
Dr. John F. Rink is committed to personalized excellence in every smile. He has been practicing for over 35 years and is a member of the:
To learn more about our services or schedule a consultation, reach our practice online or call (843) 806-3972.
If you are confused about your coverage, you can ask the staff at your dentist’s office to help you or call your insurance provider directly. You can also ask your provider for an Explanation of Benefits (EOB) which lists the procedures your plan does and does not cover.
When deciding whether to undergo a certain dental treatment, it is important to consider more than your insurance coverage. The least expensive treatment option may not be the right one for you. Be sure to discuss all aspects of your coverage and treatment plan with your dentist before making a decision.
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