Do you know what exactly your insurance plan includes? What treatment and care does your dental insurance support you with? Furthermore, what do all these trade terms like “co-pay” and “deductible” mean? Thankfully, you are already in good hands when you get dental treatment with Dr. Stephen Coates. However, fully understanding your dental plan can bring even more peace of mind and make your appointments even smoother.
Benefit Period
For some dental plans, the benefit period will last one year. For example, if you got your insurance on January 4th, 2023, also known as your “effective date”, and your end date is January 4th, 2024, that means you are covered for a whole year.
Other plans offer a calendar benefit year, meaning your benefits will start on January 1st and end on December 31st of the same year.
Payments
Regarding financial information that relates to dental insurance, there are a few key terms you should become familiar with:
- Deductible: A set amount of money you have to pay before you receive any benefits
- Co-payments: A fee that is charged per visit or treatment that does not count toward the deductible
- Co-insurance: The amount (usually a percentage) a patient is responsible for covering after a specific dental treatment after insurance has paid their portion
- Maximums:
- The annual maximum is the maximum amount a plan will pay for in the benefit period, which is usually a full calendar year
- The lifetime maximum is the total amount a plan will pay for the life of the individual’s plan (this usually applies to specific services, such as treatments)
Reimbursement Level
Different dental services are covered at different percentages with insurance and therefore have different reimbursement levels. These levels include:
- Class I: These are preventive and diagnostic treatments that are covered at the highest percentage, usually 100%. This is so patients can use preventive measures to avoid having to receive more costly and complicated treatments down the road.
- Class II: Basic restorative procedures such as extractions and fillings. They are reimbursed at a lower percentage than Class I, such as somewhere around 70-80%.
- Class III: Applies to major restorative procedures such as crowns and dentures. These are reimbursed at the lowest percentage and may even have a waiting period before being covered by your plan.
How Do I Know if a Dental Office Accepts My Insurance?
Most times, you can log into your insurance’s online portal to view a directory of providers who are in network. You can also give your favorite dental office a call to see if they are in network with your insurance. If you live in the Long Beach, CA area, consider giving Dr. Stephen Coates a call at (562) 434-6414 and our team will be happy to help answer any question that you may have about your dental insurance!
