Your Dental Insurance Does Not Pay for Everything

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A surprised look is a common sight on a patient's face while paying for their co-pays. Patients assume that dental insurance pays for everything. This is not true.

Here are some information that will help you understand dental insurance:

How much is your deductible?

Deductible is the amount that you pay one time after your first major procedure. It is an amount indicated in your eligibility of benefits. Major procedure could be a filling, a root canal, a crown, an onlay or an inlay, and so forth. Deductible is non-negotiable. You have to pay the deductible.

Remember the usual and customary fees.

Usual and Customary Fees are the fees for every dental procedure by your dental office. Apart from the schedule of fees from insurance companies, dental offices have their own set of fees. If your procedure entailed a laboratory-processed porcelain and your insurance does not pay for that but instead pay for a lower alternative procedure, you are responsible for the difference. For example, if your dental office's UCR for onlay is $895 and the insurance is only paying $350 for it, you pay $545 plus the deductible if this is your first major dental procedure.

Look at your annual maximum and always calculate what is remaining of it.

Your annual maximum is the amount your insurance will cover for the duration of the year. If your annual maximum is $1,500, this is the only amount your insurance will pay for all the procedure that you are going to have for the year. If your treatments go beyond $1,500, you are going to be responsible for them.

Anything cosmetic is not covered by insurance.

Bleaching, porcelain veneers, or anything cosmetic is not covered by insurance. You are going to have to pay out of your pocket for these. Dental offices usually have third party financing that can help you pay for these procedures, especially porcelain veneers that can cost $1,200 per tooth.

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If you are surprised to get a bill from your dental office, check your dental benefits. This will help you clarify more things about dental insurance as to why they are billing you.

Dental insurance companies are meant to lighten your financial load as far as your dental needs are concerned, but they will never foot the entire bill.

Next time you are asked to pay, do not be shocked.