How can I understand my dental insurance?

 

Dental Insurance can be very confusing to understand so let’s try and simplify:

• Annual Maximum- Insurances will contribute up to a certain amount on the total dental cost per year (on average $1000-2500 depending on the specific plan).
• Coverage- Insurances will pay a certain percentage (usually 50-80%) for treatment completed. The patient will be responsible for the remaining percentage even if your annual maximum has not been met.
• Deductibles- An initial annual fee (deductible) required prior to insurance contributing to the expense of dental treatment.
  • Example:
    • Negotiated Crown price $1250 with a $50 deductible
    • Initial patient responsibility is $50
    • Insurance pays 50% of $1200 (Initial cost minus deductible) = $600
    • Patients portion is $600
    • Total Patient Responsibility would be $650
• In-Network vs. Out-of-Network
  • In-Network Dental Providers have lower negotiated fees determined by the insurance company. The insurance company will pay a percentage on those fees.
    • Example
      • Insurance fee for a crown is $1200, with 50% coverage
      • Insurance pays $600
      • Patients responsibility is $600
  • Out-of-Network Providers use non-negotiated office fees. The insurance company will only cover the percentage of the insurance fees they have set. Thus the patient portion is usually higher
    • Example:
      • Non-negotiated office fee for a crown is $1500
      • Insurance fee for a crown is $1200 at 50% coverage
      • Insurance pays $600
      • Patient Responsibility is $900
• Downgrade- Insurance may reduce the coverage of a certain procedure to a comparable procedure.
  • Example- Silver fillings vs. Tooth Colored fillings
    • Let’s say a tooth colored composite filling is recommended
    • Price of a tooth colored filling is $200
    • Price of a silver filling is $180
    • If the procedure is downgraded to an silver filling, and covered at 50%:
      • Insurance will contribute 50% of the amalgam price, thus in this example $90
      • Patients portion would be $110 ($200-90)

Dr. Kathryn Buss at Portland Smiles accepts nearly all insurance plans and is       In-Network with most plans under Delta Dental, Cigna, MetLife, TriCare, Ameritas, Principal, Standard, Aetna.

At our office, we would gladly submit a predetermination for treatment and go over all the expected costs prior to any work being done. CALL TODAY!