Understanding Dental Coverage

  • By John Adam
  • 18 Dec, 2016

The best way to get the most out of your dental coverage is to understand its many features. For instance, most insurance companies have various plans befitting the needs and circumstances of different individuals. As well, dental benefits are calculated within a benefit period, which is typically one year (though possibly not a calendar year). There’s much to learn about dental coverage, so here are a few aspects to help you get a better idea of it, especially if there are any benefits left before the end of the year.

Maximums

Most dental plans have an annual maximum, which is the dollar amount a dental plan will pay toward the cost of dental care within a specific period, even if a patient’s costs exceed the limit. The patient is personally responsible for paying costs that exceed the annual maximum. A common annual maximum is $1000 or $1500 while some can go as high as $2000 or $3000. These totals can be individual or family maximums.

Deductibles

Most plans have a specific dollar deductible. The amount of dental expenses is the responsibility of the beneficiary before a third party can assume liability for payment of benefits. In other words, you personally have to pay a portion of your bill before your benefit plan will contribute to your costs. Each plan varies—for example, some apply the deductible to diagnostic or preventive treatments while others do not. The deductible may be a one-time charge, or it may vary depending on the program.

Coinsurance

Many plans have a coinsurance provision, meaning the benefit plan pays a predetermined percentage of the cost of your treatment. The part you pay is called coinsurance—this is paid even after your deductible has been reached. For example, you may pay 20 percent while your plan may cover 80 percent of the expenses.

Reimbursement

Many dental plans offer different classes of coverage. Each class provides a certain percentage of coverage and certain limitations and exclusions. Each plan may vary, so it’s best to go over your benefits carefully. For example, Class I may offer coverage at the highest percentage—at least 80-100 percent of the plan’s maximum allowance. Class II may cover only basic procedures like fillings, extractions, and periodontal treatment, with reimbursements usually ranging from 70-100 percent. Class III often reimburses at a lower percentage at 50 percent and may have a waiting period before services are covered.

Estimates

You may want to ask your dentist to complete and submit a request for a cost estimate. These are often referred to as pre-treatment estimates. This lets you know in advance what procedures are covered though it is not a guarantee of payment.

Exclusions

Exclusions are dental services that aren’t covered by your plan. Some dental plans are designed to help with expenses and may not cover every need, and these are referred to as limitations or exclusions. Some health groups restrict coverage for pre-existing dental conditions that are present before a patient enrolls in a plan, such as a missing tooth.

By John Adam 05 Aug, 2017
We did it! Thanks to generous donations from our clients and community members, we were able to collect  backpacks full of school supplies to kids in need. Students at received backpacks filled with crayons, markers, glue sticks, notebooks, and more.

We are so happy to be able to give back to our community, and we are committed to going the extra mile to make sure our local children can take on the school year with everything they need to succeed.
By John Adam 18 Dec, 2016

The best way to get the most out of your dental coverage is to understand its many features. For instance, most insurance companies have various plans befitting the needs and circumstances of different individuals. As well, dental benefits are calculated within a benefit period, which is typically one year (though possibly not a calendar year). There’s much to learn about dental coverage, so here are a few aspects to help you get a better idea of it, especially if there are any benefits left before the end of the year.

Maximums

Most dental plans have an annual maximum, which is the dollar amount a dental plan will pay toward the cost of dental care within a specific period, even if a patient’s costs exceed the limit. The patient is personally responsible for paying costs that exceed the annual maximum. A common annual maximum is $1000 or $1500 while some can go as high as $2000 or $3000. These totals can be individual or family maximums.

Deductibles

Most plans have a specific dollar deductible. The amount of dental expenses is the responsibility of the beneficiary before a third party can assume liability for payment of benefits. In other words, you personally have to pay a portion of your bill before your benefit plan will contribute to your costs. Each plan varies—for example, some apply the deductible to diagnostic or preventive treatments while others do not. The deductible may be a one-time charge, or it may vary depending on the program.

Coinsurance

Many plans have a coinsurance provision, meaning the benefit plan pays a predetermined percentage of the cost of your treatment. The part you pay is called coinsurance—this is paid even after your deductible has been reached. For example, you may pay 20 percent while your plan may cover 80 percent of the expenses.

Reimbursement

Many dental plans offer different classes of coverage. Each class provides a certain percentage of coverage and certain limitations and exclusions. Each plan may vary, so it’s best to go over your benefits carefully. For example, Class I may offer coverage at the highest percentage—at least 80-100 percent of the plan’s maximum allowance. Class II may cover only basic procedures like fillings, extractions, and periodontal treatment, with reimbursements usually ranging from 70-100 percent. Class III often reimburses at a lower percentage at 50 percent and may have a waiting period before services are covered.

Estimates

You may want to ask your dentist to complete and submit a request for a cost estimate. These are often referred to as pre-treatment estimates. This lets you know in advance what procedures are covered though it is not a guarantee of payment.

Exclusions

Exclusions are dental services that aren’t covered by your plan. Some dental plans are designed to help with expenses and may not cover every need, and these are referred to as limitations or exclusions. Some health groups restrict coverage for pre-existing dental conditions that are present before a patient enrolls in a plan, such as a missing tooth.

By John Adam 18 Dec, 2016

Signs You May Need a Root Canal

Having a dental procedure done is never a fun experience, and it can be uncomfortable and even painful depending on what issue exists. One of the more feared procedures among patients is the root canal – a procedure that replaces the infected pulp inside the root of a tooth with another material. Root canals are most often a required procedure for those who have deep decay within their tooth, and there are some tell-tale signs that may indicate that a root canal is needed.

One of the most distinguishable signs that a root canal may be required is when deep tooth decay reaches the “pulp chamber” of the tooth. While it may be hard or even impossible to see this happen, patients can definitely feel the pain associated with this happening. It is not uncommon when the pulp becomes infected for patients to experience acute or “horrible” pains that begin very suddenly. This is caused by the living tissue inside the tooth dying along with the nerves. However, just as quickly as the pain begins, it usually dissipates or completely goes away within a period of two to three days.

The acute pain that patients experience when the infection reaches the tooth’s pulp chamber can be almost unbearable and is often described as “excruciating.” Since this is caused by an inflammation of the tissues in the tooth, over the counter pain killers such as Ibuprofen can be helpful in managing the pain, though they will not take the pain away – this usually requires a prescription pain killer that is administered by a dentist or a specialist for root canals known as a endodontist.

While this acute pain will likely go away when all of the tissue inside the tooth dies, the infection will remain and cause further problems. Should the issue not be resolved, the infectious bacteria will move along the tooth’s root and into the bone – this is when patients will begin to feel the root when they bite down on the infected tooth. Secondary pain is then transmitted through the nerves that live in the periodontal ligament and the lining of the membrane that attaches the tooth to the bone.

If this is left untreated, it could potentially cause an acutely painful or chronic abscess, which is a much longer standing, “silent” infection that can cause a myriad of problems if undetected or left untreated. Root canals, for this reason, should be done as soon as possible or when an endodontist believes it is the right time to have the procedure done in order to prevent any future issues.

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