Many patients typically don't understand what their dental insurance policy covers, what it does not cover and limitations of their dental plan. Here are a list of highlights regarding dental insurance that your dentist in Fort Lauderdale feels every insured should know:
- Annual Maximums: This is the dollar amount your insurance will pay on your behalf per benefit period. Most dental plans run on a calendar year (Janauary 1 to December 31); however, some plans go by a benefit year (e.g. April 1-March 31 or July 1-June 30). Once your insurance has paid its maximum annual benefit, anything further is considered "out of pocket" and billed to the patient.
- Preferred Providers: Also called Participating dentist. Preferred providers are contracted with your dental insurance company. If you get dental care from someone who is not in the network, your costs out of pocket will likely be greater.
- Pre-Existing Conditions Clause: If your dental insurance has a missing tooth clause, fees associated with replacing a tooth (e.g. bridge, implant, partial denture) that was extracted prior to you enrolling in the dental plan will not be paid.
- Coordination of Benefits or Non-Duplication of Benefits Clause: (Applies only if you carry two insurances): If your secondary insurance has a non-duplication of benefits clause, they will not pay any balances unpaid by your primary insurance. If your secondary insurance has a standard coordination clause, they will likely pay any balances unpaid by your primary insurance. This is helpful when receiving what is considered "major" services (e.g. crowns, bridges, dentures, implants) for which most insurances pay 50-60% of your dentist's fee.
- Frequency Limitations: Your dental insurance will limit the number of times it pays for certain treatments. Understand this should never dictate your treatment. A dental cleaning and exam may be covered twice per plan year or once every six months (some policies will not cover a service unless it has been six months plus one day from the last time that service was billed).
- Not Dentally Necessary: Your insurance carrier may claim that a procedure is not dentally necessary and will not be covered. If this is the case, it does not mean that the treatment was not needed. Never allow your insurance to dictate what is necessary, only you and your dentist should be making that decision. Our staff are happy to send in a prior authorization to your insurance on your behalf.
- Downgrading: This is what your insurance company will do to reduce their cost. Most patients want composite (white) fillings but some insurances will downgrade the fee they pay for this service to a lesser fee for amalgam (silver) fillings which creates a larger out of pocket expense for the patient.
- Alternative Treatment Clause: When there are two ways of treating a condition the plan may only pay for the least expensive option. However this may not always be the best option.
The staff at Excellence in Dentistry in Fort Lauderdale are here for all of your dental needs and are happy to help with all of your dental insurance questions and billing. Call our office at 954-928-1666. We are conveniently located at 2480 E. Commercial Boulevard (between Bayview and Federal Highway). Dr. Nancy Rotroff and Dr. Gerard Wasselle are preferred providers for many insurance companies:
- Aetna
- Ameritas
- Assurant Health
- Blue Cross Blue Shield
- Blue Dental Choice Plus
- Cigna
- Delta Dental
- DenteMax
- Florida Combined Life
- Guardian
- Humana
- Lincoln Dental
- MetLife
- Premier Dental Group
- Principal
- Securian
- United Concordia
