Insurance Information


Dental Insurance Information

We strive to inform you of any limitations or special stipulations of your insurance policy as a courtesy. We are always happy to call your insurance company and obtain any information they are willing to share. However, your insurance company has no obligation to give us any information and all information that is given is only an estimate. Patients who carry dental insurance should understand that all dental services furnished are charged directly to the patient and that he or she is personally responsible for payment of all dental services.

As a courtesy to you will help prepare the your insurance forms and file your claim. However we do not render services on the assumption that our charges will be paid by an insurance company. Any balance is the responsibility of the patient. If you should ever have any questions regarding your dental insurance or our financial guidelines, please do not hesitate to ask for our help, we will always assist you in any way possible.

Each dental insurance policy varies which sometimes makes understanding your policy challenging. Some employers offer several different policies that may carry different levels of coverage. Here is some common terminology and what it means:

Coverage Year: Standard coverage years are calendar or fiscal. Some insurance companies set the coverage year fiscally, for example April 1, 2015 to March 31, 2016.

Maximums: Yearly maximum amounts may vary from $500 to over $2,000

Effective Date: This is the date coverage goes into effect. Knowing the effective date of coverage is important because it coincides with any waiting periods on treatment.

Waiting periods: Knowing the waiting period for certain procedures is important so you can determine out-of-pocket expenses. For example, if you need a crown, but there is a 12 month waiting period for major dentistry, your out-of-pocket expenses would be 100% instead of the standard estimated 50% if services are performed before the 12 month waiting period is satisfied.

Frequency Limitations: It is helpful to know frequency limitations for certain procedures. The standard frequency limitations written on most contracts are preventive which include cleanings, exams and radiographs. Cleanings and exams are commonly covered twice a year or every six months. The two are different and it is important to know which one applies to you. If the coverage is every 6 months, you have to wait six months to the day to have your second cleaning of the year or it will not be covered.

Replacement-of-Major Dentistry Frequency: This applies to major dental work such as crowns. The standard frequency limitation on replacement is typically once every five years. A new trend that we are seeing is replacement covered once every seven or ten years.

Periodontal Frequency Limitations: Scaling and Root Planing may have a frequency limit of two to five years. Additionally, the periodontal cleanings that are recommended following this procedure could be limited to once every 24 months.

Percentage and Fee Scheduled Policies: There are two types of dental plans: one designed to pay a percentage of an allowable fee and one designed to pay according to a fee schedule. The fee schedule plan pays a certain amount per procedure no matter what is charged by a dentist. The percentage of coverage plan is divided into categories: Preventive, restorative and major. Each category usually has a different percentage of coverage which varies depending on your dental plan. It is important to understand which one of these plans applies to you.

Non-Duplication Clauses: The standard definition of a non-duplication clause is that if a patient is covered under two plans and the primary plan pays 80% of the claim, the secondary plan will not duplicate the benefit. This makes it impossible to estimate your co-payment for procedures because this is only determined after a true claim is filed. We will try to obtain all benefits that are allowed from both of your policies.

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