Dental insurance can be complicated, and that’s because it was designed to be! Even though your dental team can help you navigate your benefits, ultimately, it can be difficult to find out what your insurance plan will and won’t cover. The good news is that there are some general rules of thumb you can use to help estimate what services your benefits will apply to. Read on to learn more about the different types of treatments that are typically covered by dental insurance.
The Different Types of Services & How They’re Covered
It’s important to note that the information below is just a general statement that applies to most (but not all) dental insurance plans. So, the best way to learn if your treatment will be covered by your benefits is to reach out to your provider directly.
Below, you can learn more about the different categories of dental procedures and at what rate they will be paid for, depending on your insurance plan. A good tip to keep in mind is that usually, if you choose an in-network provider, your out-of-pocket costs will be less.
Preventive Care
Preventive services include your bi-annual checkups and cleanings, X-rays, fluoride treatment for kids, and oral cancer screenings. These services are typically covered routinely by your insurance plan at 100%. However, it’s important to keep in mind that your plan may only cover them at a certain time (for example, a checkup and cleaning once every six months, or panoramic X-rays every three to five years).
Basic Services
Basic dental services usually include dental fillings, gum disease treatment (scaling and root planing), and sometimes basic tooth extractions. This type of dental work is usually 80 percent covered by your dental insurance plan, meaning you will need to pay about 20 percent of the cost out of your own pocket.
Major Services
Major dental procedures include dentures, bridges, crowns, oral surgery, and complex tooth extractions. Most dental insurance companies will usually cover 50 percent of these treatments, meaning that you will be responsible for paying about 50 percent of the cost out of your own pocket.
Clear Aligners/Orthodontics
Most dental insurance plans do not cover orthodontics for adults, but they will cover these services for teenagers. Coverage for clear aligners can vary more greatly from plan-to-plan, so it’s best to contact your insurance company directly to learn whether that’s included in your benefits.
Getting Accurate Cost Estimates
The best way to get a cost estimate and not end up with a surprise bill after your appointment is to do two things. In addition to having your dental team complete a pre-benefits check before your treatment, it’s a good idea to also call your insurance company to make sure they tell you the same thing they told your dentist. Your dental team will then file any claims on your behalf to help you maximize your benefits and your savings.
About the Practice
At The Elegant Dentistry, we are proud to be in-network with most major PPO dental insurance plans, which means that we are able to offer our patients discounted fees. If we aren’t in-network with your insurance plan, we are happy to still maximize your benefits by filing claims on your behalf. Our team strives for transparency throughout every aspect of your care, so please don’t hesitate to reach out if you’re confused about your insurance benefits! To learn more, visit our website or call 469-598-1023.
