Imagine this. You are sitting back and relaxing, watching Netflix. You reach for the last bite of popcorn… and ouch! Can you believe you just damaged your tooth!
Hefty dental bills can come take you by surprise almost anytime. That is why having dental insurance in place makes sense. It protects your out of pocket costs when the unexpected happens – to you or your family members.
Before choosing which dental plan to go with, here are five factors to keep in mind.
The Waiting Period
Some insurance plans have a waiting period, meaning a period of time that must pass before you submit any claims. Keep in mind you can’t file claims later on for services that occurred during the waiting period. Most plans have a waiting period of up to three years for major services like bridges and dentures.
This waiting period could limit your options if you are in need of specific dental treatment. Check your plan to see if there is a waiting period, and have a conversation with your dentist about what treatment you may need at that time, and whether anything can wait until the period is over.
Before you switch plans or purchase a new one, it’s always a good idea to have your ducks in a row. Talk to your dentist, find out the parameters of your plan, and make your decision based on your, and your family’s needs.
Pre-determinations, or estimates, are sent to your insurance company by your dental office, listing a proposed treatment, the dental codes and costs, and x-rays if needed. Your insurance company will then determine whether or not a treatment is eligible for reimbursement and how much it will reimburse you for.
Sending an estimate to your insurance company is an important step. After all, what happens if you go ahead with treatment, only to find out that your plan won’t cover it? Having that information in writing is crucial in your decision making.
Estimates aren’t meant to be roadblocks or to slow down the process. They are there to help you make an informed decision on your dental care. Thanks to modern technology, most estimates can be sent electronically, making the process much faster than it used to be.You can usually get an answer within a week, sometimes even days, so what have you got to lose?
If you don’t confirm that your treatment is covered, you won’t know for sure until after it’s done — and you risk being responsible for hundreds, sometimes thousands, of dollars.
Most plans have a maximum dollar amount that you are allotted each year for dental services. For some programs, this year will run by the calendar (January to December), and for others it may be twelve consecutive months (i.e. April to March the following year). This maximum is on a per person basis, meaning you do not share a maximum with another family member.
If your plan allows a maximum of $1000 per person, per calendar year, you are responsible for any charges above that $1000. Your maximum does not carry over from year to year, and it does not accrue, so keep your maximum in mind.
The British Columbia Dental Association for example, can give you an idea of what the suggested fees are for each procedure, but an estimate is still required.
When you’re looking over potential plans, remember that a plan that has a lower monthly premium and a lower annual maximum could be more expensive in the long run. If you regularly need more treatment than your plan covers, paying out of pocket could end up being a routine year after year. You’ll save money choosing a better plan with a higher monthly premium.
Your dental insurance plan will cover certain routine services such as scaling, polishing, exams, and x-rays. These procedures are commonly known as “recall” services. Every plan has a limit on the frequency of these procedures, and this may affect both your treatment and finances.
For example, if your plan allows a recall visit every nine months, you will only be reimbursed for the services if they are performed every nine months. If you can’t remember the last time you had a recall visit, you can either check with your dental office or call your insurance provider directly.
Depending on the condition of your oral health, your dentist may request that you come in for recall visits more frequently than the limitations outlined by your plan. You might be able to negotiate more units of scaling if your dentist provides X-rays and a report on your periodontal needs, but this is rare.
Recall exams, x-rays, and polishing, however, are bound by the terms of your plan and cannot be reimbursed beyond the established recall frequency. If you need to, you can find another plan that will reimburse recall services more frequently, or you can accept financial responsibility for these services and pay out of pocket.
The Canadian Dental Hygienists Association also provides suggested fees, but keep in mind that they may not be the same codes and fees that your dentist charges.
Some dental services may be ineligible for coverage under your plan. Most, if not all plans exclude dental implants for example. If your dentist sends an estimate for anything not covered under your plan, you will have the decision in writing.
There may be different clauses in your plan preventing you from getting the most expensive treatments. Perhaps your dentist wants to give you a bridge, but your plan can only pay for appliances that are replacing teeth that were lost while you were covered under the plan. Or perhaps your dentist wants to try a newer treatment that isn’t yet recognized by private insurance plans.
This brings us back to the need for estimates. If you’re expecting your plan to cover a procedure, it’s a very good idea to get confirmation in writing from your insurance carrier. If you’re prepared to pay out of pocket, that’s up to you, but it’s better to be prepared than to get blindsided by an enormous dental bill!
Here’s the most important thing for you to known
The best thing you can do to get the most out of your dental insurance plan is to contact us at SBIS and learn more about how insurance works. One of our experienced specialists can simplify the complexities of insurance policies and help you decide what plan best suits your needs.
Our knowledgeable customer service reps have all the information you need to make smart decisions about your family’s dental health. Contact us today so we can point you in the right direction — toward better oral care!