Dental Insurance Articles
Dental Insurance And What It Will Typically Cover
2010-09-22
Dental insurance companies offer a variety of dental plans. The procedures that are covered by a dental policy typically depend on the type of plan an individual chooses and the premium paid for it. The best way for an individual to determine the coverage offered by various plans is to request a dental insurance quote from different providers and to do a side-by-side comparison of the available options.
Dental insurance carriers typically cap the amount of money they are willing to pay each year for each insured individual. In most cases, the yearly maximum is around $1,000 to $1,200. The amount renews automatically at the start of each year. However, it is important to realize any unused benefits will not be carried over to the next year.
Typically, insurance companies classify dental procedures into three categories for eligibility and claims purposes. The three categories are preventative, basic or restorative, and major. The procedures that fall under the preventative category include routine cleanings, dental examinations, X-rays, sealants and Fluoride. It's important to realize certain procedures that are considered preventative by one provider may be considered as restorative or basic by another provider's dental policy. The distinction is important, because the amount of coverage that is available under each category can vary by insurance carrier.
Basic or restorative procedures are simple tooth extractions and fillings. Root canals may be considered either basic or major depending on the dental policy. Most insurance companies consider dentures, dental implants, crowns, bridges, and partials and surgical extractions as major procedures. Meanwhile, very few insurance companies cover dental cosmetic procedures such as teeth whitening and porcelain veneers. A dental insurance quote spells out what the provider is willing to pay for each procedure.
Most insurance companies use what's known as a usual, customary and reasonable (UCR) standard to set the amounts they will pay for each procedure. The rates vary by region. While one carrier might pay $100 for a tooth extraction, another might only pay $90 for the same procedure in the same geographic region. The rates quoted by the insurance provider are the rates they are willing to pay to dentists within their own networks. The amount that a provider is willing to pay for out-of-network dentists can be quite different. Dental insurance providers also have different rules regarding the co-payments that individuals have to make to the dentist. Typically, dental insurance companies require patients to pay a fixed annual deductible upfront for dental procedures, before the insurance payments start kicking in. The first $150 to $200 in annual dental fees is usually borne by the patient. The insurance starts paying once the deductible amount is exceeded.