Many people think that dental insurance is the same as medical insurance, and are shocked when they find out it isn't. How does dental insurance work? We can think of it as a coupon or a voucher that allows the patient to receive a limited amount of dental services. And when I say "limited," I really do mean "limited" when compared to the coverage that one receives through medical insurance. Dental insurance providers have all kind of limitation on how this amount can be used. Sometime they put 6 months to 1 year waiting period . Many time they severely limit the procedures which can be done.
Most dental insurance plans give the patient a 1000-2000$ a year maximum.It is the same amount which they first started offering in late 60s. There is often a deductible. What this means is that before insurance starts paying, the patient needs to pay deductible out of pocket first.
"Preventive" procedures such as exams, x-rays, and basic cleanings are usually covered at 80-100%.
"Basic" procedures such as fillings, extractions, root canals, and deep cleanings are covered at 50-80%.
"Major" procedures such as crowns,bridges and orthodontics are covered at 0- 50%.
These categories esp. Basic and Major are different with different insurance carriers and more push nowadays to move the treatment in major category
Now, if you happen to need a lot of dental work, the 1000-2000$ yearly maximum may not be enough. And this is when the comparison to medical insurance really shows: with medical insurance, if you have several health problems, most insurance plans will pay significant portions of the treatment costs, sometimes upwards of 50,000$. Now when these same patients expect their dental insurance to do the same, they are in for a nasty surprise. Imagine that you need significant of dental treatment, and your insurance plan was only going to pay 1000$, and you'd have to pay the remaining amount out of pocket. This is the reality of the health care system,
Now, it has always been our philosophy to never let money be an obstacle in obtaining the dental treatment you need. That is why we offer patients several options for financing their dental treatment:
1) They can sign up with a third party credit company like Spring Stone or Care Credit.
2) If they don't have insurance, or if their insurance has been maxed out, they can join our membership plan and save 20-40% off dental treatment.
3) They can pay for their treatment in monthly installments that are realistic for the patient's unique financial situation.
So there it is, dental insurance 101, until next time