Medical nsurance policies don’t cover the cost of dental care. Dental insurance has to be purchased separately and there are several different plans for those. Just like medical coverage, patients have to pay a certain amount of the cost from their pocket. These are called co-payments or deductibles. It is essential for a consumer to go through the different plans and pick the one that they need and can afford.
Every dental plan differs in its reimbursement policies. Payments are done on the basis of classes of service. Basic services like preventive care and diagnosing conditions get covered 100%. Services like fillings which are considered restorative are covered 80%, major services like crowns and root canals are covered for 50% of the cost. Cosmetic procedures are usually not covered. There are restrictions on how many times a patient can visit the dentist. Check the plans before signing up – claims can be denied by insurance carriers.
A class usually defines the type of treatment that a patient needs. Dentists will determine it after diagnosing – it could be preventive, basic restoration, major or complex treatment.
It is essential to know what is included under your plan. Consumers have a few to choose from - a Dental Preferred Provider Organization, Dental Health Maintenance Organization, Dental Indemnity Plan or a Dental Discount Plan.
Most dental clinics do the paperwork on behalf of the patients. In cases where the patient has to file a claim on their own, they have to do the following:
It is important for patients to understand their plans and available benefits so that they can avoid getting unnecessary treatment.