What will your insurance pay for? A few things to know

Why won’t my insurance pay for that?  
A few things to know about dental insurance.
  • Dental insurance usually pays a % of what we treat at our dental office.
    • 100% for for the check up, cleaning and X-rays.
    • 80% for dental fillings, root canals and taking teeth out.
    • •50% for the more expensive things, like crowns, implants and dentures.
  • Just as important is to know the yearly maximum.  That’s the amount the insurance company will pay for all your dental care for that year.  They may provide 50% coverage for your dental implant and crown, but if you have a $1,000 maximum, that’s all they will pay for everything for a year.  So that is very important to know, so you know how much your out-of-pocket cost could be.
  • Insurance will select to pay for the “least expensive, clinically acceptable procedure“.  So for fillings on back teeth, they often will only pay for a silver filling, which is cheaper.  If a tooth colored filling is placed, you will have to pay more; anywhere from $20-$50 more.  The same may happen for a tooth-colored crowns on back teeth.
  • Some of the inexpensive dental insurances may not cover any of the more expensive things like crowns one dentures.
  • When I recommend a more expensive procedure like a crown or implant, we usually want to submit a “pre-estimate of benefit” to your insurance company.  It takes 2-4 weeks, but we will find out what the insurance will cover, how much you will have to pay, and whether the yearly maximum will be an issue.
  • Some insurance plans may limit how often they will pay for certain procedures.  They will usually only pay for a dental cleaning every 6 months, or with some plans, twice a year.  They may pay for only 2 exams or checkups per year.  So if you come in another time for a problem, they may not pay for the exam we complete.

The best thing is to familiarize yourself with some of the basics of your coverage.  If we recommend more expensive things like crowns or implants, we suggest checking with the insurance to make sure you know what they will pay so you know what will be your share.