Commonly Asked Insurance Questions

 

-What is a Dental Maximum? And how does it work?

– An insurance maximum is the most money your dental insurance will pay toward your dental care in one benefit year. These amounts are reset yearly. After that amount is used, the patient is responsible for the remaining costs until the benefit year resets.

 

-What are Dental insurance deductible and a Medical insurance deductible?

-A dental deductible is typically a much lower amount that resets annually.

-Once dental insurance deductible has been met, the insurance company begins paying a set percentage of covered services.

-A medical deductibles can be higher amount often must be met before most services are covered.

-Once your medical deductible has been met, you pay a coinsurance and/or a copay.

 

-Why do I have a Maximum Overage when insurance says they cover at 100%?

-A maximum overage means your insurance provider has paid their set limit for your treatments within a single year plan. You have exceeded this dollar amount, making you responsible for the additional costs.

 

-Will my oral surgery be covered under Dental insurance or Medical insurance?

-Oral surgery can fall under two types of insurance (dental or medical) depending on the nature of your procedure.

-Dental insurance typically covers procedures related to the teeth and gums, such as:

-Tooth extractions and impactions

-Dental Implants

-Medical insurance may apply when the surgery is medically necessary, such as:

-Impacted wisdom teeth

-Biopsies or removals of oral pathology

 

– Can I use both medical and dental insurance for the same procedure?

-Yes, in some cases both types of insurance can be coordinated to cover a procedure.

-For instance, if impacted wisdom teeth are covered under medical, the dental insurance can cover another portion of the procedure like extractions.

 

-Are implants covered under dental or medical insurance?

-Dental implants are typically covered under dental insurance.

 

-How are my benefits checked?

-After your surgery appointment is scheduled and with complete insurance information, our insurance coordinator checks your insurance. We gather information like your maximum, deductible, a list of codes that are commonly used in our practice, along with any frequencies and limitations that may apply to some of these codes.

-We use this information that we gather from your insurance carrier to provide you with an itemized breakdown of what we estimate your carrier to cover and what we are estimating to collect from you on the date of your oral surgery.

-The plan information that the insurance carrier gives out is never a guarantee of payment and thus every patient is responsible for the difference.

 

-I was quoted a price but after the surgery took place I am billed for a different amount. Why?

-Dental bills often differ from quotes due to insurance discrepancies, such as in-network negotiated rates, annual maximums being met, or procedures not being fully covered. Your insurance may have paid less than anticipated or denied a claim