Happy New Year everyone! As the year 2014 gets off to a new starts, I thought it would be a good idea to go over some common questions on dental insurance and dental benefits.
Question: "I have new dental insurance. Does it cover everything?"
Answer: It really depends on the type of services being done. Each insurance plan is different, and can vary by each individual and company. The best way to find out much is covered by the insurance and how much the patient portion is to contact the dental insurance and to get a benefit breakdown.
Question: "What does PPO mean?"
Answer: PPO stands for Preffered Provider Organization. An office that is signed up to be a PPO for a dental insurance means the dentist and its providers at the office has agreed to accept the insurance's fees and benefit coverage by being in the insurance's network. If an office is not a PPO with your dental insurance, it does not prevent you from going to that office; it just means your benefit MAY differ. The best way to find out again is to check with your dental insurance company and inquire about benefit details.
Question: "My insurance doesn't cover it. That means I don't need it right?"
Answer: Unfortunately no. For example some insurance plans will not cover full coverage porcelain crowns when a tooth has suffered a large cuspal fracture, or if the decay has caused need for a root canal and/or crown. Without a full coverage crown, the tooth has a chance to further break off at the gum line, causing possible need for extraction. Your dentist will be able to discuss the best treatment options with you and why such services are needed or not needed.
Question: "Why do I need a deep cleaning? There is an out of pocket expense. Can I just get a regular dental cleaning instead?"
Answer: A deep cleaning is highly recommended in cases of periodontal disease. A deep cleaning is the very best way to control periodontal disease and to remove bacteria and tartar/calculus buildup that is underneath the gumline. While a regular dental cleaning/adult prophy is helpful, it does not allow your dentist or dental hygienist to remove the bacteria/buildup trapped underneath the gumline.
Question: "What do these terms mean: Preventative Services, Basic Services, Major Services?"
Answer: Preventative Services typically refers to regular adult and children cleanings/prophy, exams/checkup, fluoride, and x-rays (ie. bitewings, periapicals, and full mouth series).
Basic Services often include dental fillings (resins and amaglam), tooth extractions, and root canals.
Major Services usually refers to buildups, crowns, implants, dentures, nightguards, and orthodontics (braces).
Because the benefit level is specific to each dental insurance plan, be aware what one insurance may cover, another insurance may not.
Question: "What is a deductible? Why do I have to pay it?"
Answer: A deductible is a contracted fee the dental insurance company sets, and will differ by each plan and service type. The deductible is usually a one time payment per year your dental office will collect the amount when services are performed. Your plan has specific guidelines on when and which services the deductible applies.
Question: "What are names of a few dental insurance companies? Can you recommend one?"
Answer: Each dental insurance company and its plans have its pros and cons. The best way to find out which plan is suitable for you and your family is to discuss with your dentist to find out your long term needs. Some names of common insurances include Aetna Dental, Metlife Dental, Premera, Blue Cross/Blue Shield, Delta Dental, Guardian, Standard, and Cigna.
If you have any specific questions regarding insurance and its benefits, be sure to contact your family dentist.
Wishing everyone's 2014 off to a great start, from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com
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