Here are the top 5 things we think you should know about your dental insurance:
1. As a convenience and courtesy to our patients, North Delta Dental accepts direct billing to most dental insurance plans. Any co-payments or deductibles are due at the time of treatment from the patient. However, if we are unable to confirm the details of your insurance plan at the time of your dental visit, then you will be responsible for the full amount of treatment and will instead be reimbursed directly from the insurance company after we submit your dental claim on your behalf.
2) Current privacy laws prevent us from knowing the complete details of your dental insurance coverage. This includes whether it is active, the procedures and amounts covered by the plan. It is imperative that any concerns you may have about your coverage, that you look into the details. This can be done by either calling the insurance company or looking up through online access. Only you have full access to your plan details and we rely on you to share this information with us.
3) Most dental insurance plans have annual limits. These limits do renew on an annual basis; however, it is important to know whether this is on a calendar year basis or a rolling 12 months basis. Every plan is different. Again it is important that you are aware of these limits.
4) For dental treatment that is covered under “major work” on dental insurance plans like crowns, bridges and orthodontic treatment, pre-approvals will be sent to your insurance plan on your behalf to confirm the amount of coverage. Some insurance companies will send these pre-approvals to the patient. It is important that you send us this copy as soon as you receive it so we can help you decipher the dental jargon and so that your treatment does not get delayed.
5) Some patients have the benefit of “dual coverage” (their own plan and a spouse’s) where in combination the dental insurance plans may pay up to 100% of dental treatment fees. However, some plans have specific rules where they will cap out at a certain fee for a specific procedure. So even though you and your spouse both have a plan that covers 80% for treatment fees (for example), this does not necessarily mean the treatment will be covered fully to 100% of the actual fee; there may be a small portion not covered. Again, this is not information that we are always privy to due to due privacy laws. It is important that you are fully aware of what your plan entitles you to in order to avoid any surprises.