4 Useful Tips for Understanding Your Dental Insurance

September 17, 2020

Filed under: Uncategorized — dooley @ 4:01 pm
Piggy bank on model of teeth

Is it time for your six-month dental checkup? Is the toothache you’ve been ignoring desperately in need of treatment? If you answered “yes,” then you may have one important question on your mind: How much will it cost? While the answer to this question can be found in your dental plan, it can be difficult to decipher the fine print on your own. Therefore, a dentist in Wall Township is sharing four useful tips for understanding your dental insurance!

#1. Get Familiar with the Terminology

  • Benefit period – This term refers to the length of time between the “effective date” and the “end date” where coverage is available.
  • Co-payment – This is a flat fee per visit or treatment that the patient is responsible for.
  • Deductible – This is the dollar amount the patient must pay out-of-pocket before the insurance company pays for treatment, much like homeowner or auto insurance policies.
  • Waiting period – If your plan has a waiting period for a certain treatment, like root canal therapy, then you are not eligible for coverage until after that length of time.

#2. Look for “100-80-50” Coverage

One of the easiest ways to understand what is actually covered in your dental plan is to look for the sequence “100-80-50.” This refers to 100% of preventive care being covered, 80% of minor procedures, and 50% of major treatments. So, a routine dental checkup will be paid for through your dental insurance, and a $400 filling can end up only costing you $80!

#3. Understand What “Out of Network” Means in Dentistry

In the medical world, “out of network” typically does mean “out of coverage.” However, the same does not always apply in dentistry. In fact, a dentist who is out-of-network with your plan may still accept your insurance, but the coverage will be less compared to an “in-network” dentist.

#4. Ask Your Insurance Company or Dental Team for Help!

Between the unfamiliar terminology and the fine print, it can be difficult to decipher what your dental plan does and does not cover. Fortunately, your insurance company and dental team can help! Both parties handle dental plans daily and are happy to help you understand your coverage. That way, you can get the dental care you need and know the cost upfront.

If attempting to understand your dental insurance is giving you a headache, then you are not alone. Fortunately, you can use the above four tips to help!

About the Author

After earning his Doctor of Dental Medicine, Dr. Edward J. Dooley worked as a Dental Officer in the Navy before opening his practice in 1986! Today, he has completed over 1,500 hours of continuing education and is an active member of multiple professional organizations (including the American Dental Association). If you have questions about your dental plan or are overdue for your biannual appointment, visit his website or give him a call at 732-974-2288.

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