WHAT IS AN ANNUAL MAXIMUM AND ARE CLEANINGS SEPARATE FROM MY MAXIMUM?

An annual maximum is the total amount your dental insurance company will pay for dental treatment rendered during the plan year. Most dental plans are based on a calendar year, however, some select a plan year that corresponds to when their group's benefits renew (or open enrollment).

Cleanings are not separate from your annual maximum. If your annual maximum is $1,000, your cleaning are deducted from this amount.

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WHAT IS A WAITING OR ELIMINATION PERIOD?

This is the length of time before your insurance company will pay their portion of the bill. The waiting period begins when you have enrolled in your dental plan. Not all plans have waiting periods.


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WHAT DOES IT MEAN WHEN MY INSURANCE COMPANY WILL NOT PAY FOR SOMETHING DUE TO FREQUENCY?

This means your insurance company will only pay their portion when you've met their criteria for specific treatment or care. For example, some insurance companies allow two cleanings anytime during a year, while others allow 2 cleanings per year, six months apart. If the latter is the case, such as your next cleanings appointment is 5 months and 20 days from your last cleaning, your insurance company may not pay their portion due to 'frequency'. Although it is the patient's responsibility, we help to alleviate that burden by trying to ensure your cleanings are at least 6 months and 1 day apart from each other. It's important to note that you fall into the category where you may need more than two per year, you may be responsible for the extra cleaning..

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HOW DO WE KEEP TRACK OF YOUR ANNUAL MAXIMUM ALLOWANCE?

We submit a claim to your insurance company when your dental care is performed. Upon receipt of payment from your insurance company, we update your account with the amount they have paid. Our software keeps a running total of these payments. At your request, we can give you an accurate balance provided there are no outstanding payments we are still waiting for. It is also important to note that if you visited another dentist during the year unbeknownst to us, that would affect your maximum. Upon request, we can call the insurance compnay to find out the remaining balance.

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WHY DOES MY INSURANCE COMPANY PAY DIFFERENTLY DEPENDING ON THE SERVICE I RECEIVE?


Generally, insurance companies will pay a different percentage depending on the type of treatment you receive. There are three most common categories that are used: preventive (Type I), restorative (Type II), and major (Type III). Cleanings are considered preventive care. A filling would be restorative, while crowns would be considered major dental treatment. The most common percentages we see are preventive at approximately 100%, restorative at approximately 80%, and major at approximately 50%, however, this is not the case for all dental plans. An insurance company may offer different packages to employers. Your group benefits depends on the package your employer chooses.

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WHAT IS A DEDUCTIBLE?


A deductible is an amount that you must pay before your insurance company will pay their portion. For example, it's January and you get a filling. Your annual deductible is $50 and restorative is covered at 80%. You will pay the first $50, then you're insurance company will pay approximately 80% of the *'accepted' difference. Your total out-of-pocket will equal the amount of the filling less what the insurance company pays.


* see next answer for what 'accepted' means.

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WHY DO I STILL RECEIVE A BILL SOMETIMES, EVEN THOUGH I PAID MY 'ESTIMATED' OUT-OF-POCKET AND MY INSURANCE COMPANY HAS PAID THEIR PORTION?

As with each dental practice, we have a schedule of charges for dental treatment. Just the same, each insurance company has their own schedule of charges for dental treatment that they are willing to pay. When you receive a bill after paying your 'estimated' out-of-pocket, it is because your insurance company paid the percentage based on their own schedule of charges for your dental treatment, as opposed to ours. Because some of our patient's dental plans have similar fee structures to ours or do not have a dental plan at all, we charge the patient the difference between our charge and the dental plan's allowance, so that all our patients are paying the same amount.

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WHAT INSURANCE PLANS DO WE ACCEPT?


We accept all dental plans that allow you to see any dentist. Check to be sure your dental insurance company did not send you a list of dentists that you can see. We encourage our patients to check their dental benefits before starting treatment, so they are comfortable with the level of coverage they can expect to receive. We can verify this for our patients upon request.

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I GOT A 'WHITE' FILLING, MY PLAN PAYS 80% OF RESTORATIVE DENTAL TREATMENT, SO WHY DIDN'T THEY PAY 80%?


Composite ('white') fillings are not required to restore your teeth. They are an alternative to the amalgam ('silver') fillings for cosmetic purposes. Typically, insurance companies will only pay their customary amount when the 'white' filling is for the front six teeth, such as canine to canine or eye teeth to eye teeth. For other teeth, your insurance company may only pay based on approximately 80% of what the cost would have been for a 'silver' filling. The difference of the amount is, therefore, billed to the patient.

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