Dental Benefits

Putting Your Money Where Your Mouth Is

If you are like most people you think seriously about health insurance and the need to cover the costs of treatment for serious medical conditions or accidents. That is natural. But what about your dental insurance needs and requirements. Although Dental disease may not be as common, being protected by dental insurance and using it wisely are essential for you and your family.

Essential Facts about Dental Benefits and Privacy Legislation

As of January 1, 2004, privacy legislation came into effect. Insurance companies will no longer provide us with information regarding your insurance coverage.

Your personal information, including your credit card and payment information, will be handled by our staff who are trained in the appropriate uses and protection of your information. Rest assured that the storage, retention and destruction of your personal information complies with existing legislation. We recommend that you get updated information from your insurance company before making dental appointments. As a courtesy to our patients, we are happy to help you understand your insurance coverage.

If requested, our staff will assist you in obtaining a pre-estimate of treatment fees, which can be sent to your insurance company for confirmation of your coverage. This will enable you to plan ahead and arange your finances accordingly, before commencing with treatment.

Is there a charge for missed appointments?

Medical versus Dental Disease

Although medical disease can be both unpredictable and catastrophic, most dental diseases are preventable. Preventive care, which includes having regular checkups and cleanings, is the key to maintaining your dental oral health. Regular visits to your dentist can lead to problems being diagnosed early and treated without extensive testing or elaborate and expensive procedures. In effect, this keeps dental care costs much lower than those for medical care.

What routine corrective treatment is covered by your dental plan?

This is a question that most patients want and answer to! What share of the costs will be yours? While preventive care does decrease the risk of serious dental disease, additional treatment may be required to ensure optimal health. A broad range of treatment can be defined as routine. Most, but not all, plans cover 70 percent to 80 percent of such treatment. In some cases, medical plans will actually cover 100% of the costs. Please be aware, that all patients are responsible for any and all remaining costs that are not covered by your dental plan.

Examples of routine care include:

Restorative care - amalgam and composite resin fillings and stainless steel crowns on primary teeth

Endodontics - treatment of root canals and removal of tooth nerves

Oral Surgery - tooth removal (not including bony impaction) and minor surgical procedures such as tissue biopsy and drainage of minor oral infections

Periodontics - treatment of uncomplicated periodontal disease including, but not limited to, scaling, root planning and management of acute infections or lesions

Prosthodontics - repair and/or relining or reseating of existing dentures and bridges

It is imperative that you understand what routine dental care is covered by your plan, and what percentage of the costs you will be responsible for paying.

Will your Dental plan allow for referrals to specialists?

Some plans limit referrals to specialists. Your dentist may be required to refer you to a limited selection of specialists who have been contracted with the plan's third party. You may also be required to get permission from the plan administrator before being referred to a specialist. If you choose a plan with these limitations, make sure qualified specialists are available in your area.

If you have children, you may prefer a plan that allows a pediatric dentist to be your child's primary care dentist. Since specialized treatment is generally more costly than routine care, some plans discourage the use of specialists. While many general practitioners are qualified to perform some specialized services, complex procedures often require the skills of a specialist with specific training.

Will the plan provide benefits to patients who may also be covered by another dental plan?

It is not unusual to be eligible for dual benefits. You may be covered under your company's plan as well as under that of your spouse's employer. In analyzing your options, you should make sure to look for a plan that enables coordination of benefits of both plans.

In some cases, you may be entitled to either 100 percent coverage or some form of premium credit. By coordinating benefits, you can possibly eliminate being penalized or denied coverage when the two plans have conflicting exclusions. To reiterate, it is in your best interest to ensure that you are fully aware of your plans and their respective coverages.

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