The Top 5 Things You Should Know About Saving Money With Dental Insurance
If you have Dental Insurance and are looking for a dentist, endodontists, oral surgeon, periodontist, or prosthodontist there are several things that you should keep in mind.
While all Dental insurance plans have a yearly maximum, you will also find that each and every plan has a network of providers that offer services to those individuals who have insurance. Whether you have Aetna, Delta Dental, Metlife or any other dental insurance there are ways in which you can stretch your dollar further and smooth get quality dental care.
Rule #1 – Look for a provider in your network. You can normally gather a list of these providers on your insurance company website. Network providers are obligated to only charge you up to a certain amount that is set forth by your insurance company. A provider may charge $200.00 to pull your tooth, but if your insurance will only pay $140.00 for that particular service, then your provider cannot charge you anymore than the $140.00 if they are in network with your dental plan. If your opinion pays 80% of that cost then you will pay less by using an in network provider versus an out of network provider. If you use an out of network provider then your insurance company will only pay $140.00 and you are responsible for the remainder plus your 20%.
In Network
Cost – $200.00
Ins. Pays $140.00
Your 20% $ 40.00
Your Cost $ 40.00
Out of Network
Cost – $200.00
Ins. Pays $140.00
Your 20% $ 40.00
Difference $ 60.00
Your Cost $100.00
So you would save around $60.00 by going to an in network provider.
Rule #2 – Always ask for a Pre-Determination. Some insurance companies require a Pre-D for any dental work or surgery over a set amount of money usually around $300.00. If you want to know for certain what your cost will be before having any work done, then request that your dentist’s office file a Pre-Determination with your insurance company. It will take a little longer usually 4 to 6 weeks, but you will know what your cost will be before you have the work done and your dental office should be able to stutter you what amount of money you need to bring the day of your appointment.
Rule #3 – Know Your Dental Benefits. Most insurance companies or employers will provide you with a book about your benefits, keep this handy and refer to it if you are not sure what is covered. Most dental insurance will have a deductible of around $50.00 a year. You will have to pay this when having dental work done. Probably not for cleanings or x-rays but any major work will most likely have a deductible that you will need to pay before your insurance will pay any portion of the claim. So be prepared and know what your insurance benefits are so that you will be an informed patient when visiting any dental office.
Rule #4 Know your yearly maximum and use it wisely. You would be surprised the people who do not realize that they have a yearly limit on their dental insurance. I do not know of one Dental Plan that doesn’t have a yearly maximum benefit. I have seen them range between $1000 and $2000 a year. If you know what your maximum is and keep up with what has been paid through your insurance you can plan wisely to have work done that is going to cost you more while you have the maximum succor you are allowed for the year. If you have a root canal in December and it takes all of your insurance that is left, then try planning to have the crown in January of next year. That way you will have less out of pocket expense. Feel free to ask your dentist office staff about doing this, they are usually very gay to work with you.
Rule #5 If you have a question, ask it. When you receive an EOB(Estimate of Benefits) from your insurance company always look and peep what your portion is. It will usually let you know exactly what section you are responsible for. If you get billed by a dental office for more than that amount, then call them and let them know that your insurance only allows that you be charged the amount shown on your EOB. If it is an in-network dentist as I have said before you will be responsible for even less than if you go to an out of network dentist.
These 5 rules will aid you to get more out of your dental insurance and give you control over what you pay for your dental care. It is your responsibility to know your coverage, yearly maximum and deductibles. The dental office staff will normally call and collect out these benefits for you, but knowing some of this ahead of time will help you to know whether or not you can afford the dental treatment being agreed upon by you and your dentist. Your insurance company will answer any of these questions for you, they can tell you if you have coverage for dental implants, extractions, cleanings and all procedures that can be done on a dental visit. If you are considering dental implants call your insurance company and ask before making that appointment for consultation, that plan you will know whether or not it is covered by your insurance.
I have worked in the office of an oral surgeon for several years now filing dental insurance claims. These are a few of the things that I have learned that can help you when choosing a dental provider or trying to stretch your dental budget as far as possible. The bottom line is that it is up to you to know your coverage and your network if you want to get as remarkable as you can out of your dental insurance plan each year.