Dental Insurance FAQ Overview
When you call as a new patient or an existing patient with a dental insurance policy we at Michael P Murphy DDS Murphy Dental will prioritize obtaining the necessary details from you to call your dental insurance company and receive all the details of your dental coverage and schedule your requested dental appointment.
We will contact you personally after we receive your benefit details if we notice our status is non-payable to Dr. Murphy. We input the details of your frequencies for cleanings, x-rays, exams, periodontal maintenance, crowns, onlays, inlays, bridges, implants, dentures, missing tooth clauses regarding previous extractions, and input the details into your file regardless of any treatment or treatment scheduled.
We value the detail we access for each of our patient’s specific dental insurance plans Due to the massive amounts of dental insurance plans, discount plans, online dental plans, and dental insurance through each employer we at Murphy Dental strive and take pride in educating each patient on their dental insurance plan benefits.
Due to the continuous purchasing and combining throughout the calendar year dental insurance coverage or benefits may change, we diligently communicate and correspond directly with your insurance company. We have not or do not anticipate but it is stated within each individual’s dental insurance plan that it’s never a guarantee of payment. We highly recommend pre-treatment estimates to document insurance estimates of payment with patient treatment categorized in the basic or major structure.
Dental Care Expenses Can Seem High for a Variety of Reasons
One reason is that dental procedures and materials can be costly. For example, dental crowns, bridges, and implants are made of expensive materials such as porcelain or titanium, and they require specialized training and equipment to place.
Dental Insurance Isn’t Always Comprehensive
Another reason dental care can be expensive is that it is not typically covered by health insurance plans to the same extent as medical care. Many insurance plans have lower coverage limits for dental procedures or exclude certain procedures altogether, which can make the cost of care more expensive for the patient.
Operational Costs and Overhead
Additionally, the cost of running a dental practice can be high. Dentists have to cover expenses such as rent, salaries for staff, and the cost of dental equipment and supplies. These costs can be passed on to patients in the form of higher fees for procedures.
Competitive Constraints
Lastly, the supply and demand of dental care also plays a role in cost. In certain areas, there may be a shortage of dentists, which can drive up prices due to less competition.
Dental Insurance Can Help to Offset Dental Costs
It’s important to research and compare dental insurance options and dental care providers, and to understand the coverage and costs before making a decision.
What is Dental Insurance?
Dental insurance is a type of insurance that helps cover the costs of dental care, such as routine check-ups, cleanings, x-rays, and procedures such as fillings, extractions, and more. Dental insurance plans vary, but many require policyholders to pay a monthly premium, an annual deductible, and a co-payment for each visit or procedure.
Some plans also have a maximum annual benefit or limit on the dollar amount of coverage. It’s important to review the details of a dental insurance plan before enrolling to understand the coverage and costs associated with it.
Is Dental Insurance Worth it?
Dental insurance can be worth buying for some people, as it can help cover the cost of necessary dental care such as regular check-ups, cleanings, and fillings. It can also help with the cost of more expensive procedures such as crowns, bridges, and orthodontics. However, there are also some limitations to dental insurance that should be considered before buying a policy.
Some dental insurance plans have annual limits on the amount they will pay out, and others have waiting periods before certain procedures are covered. Additionally, many plans do not cover the cost of a dental treatment that is considered to be “cosmetic”. Teeth whitening and veneers are two examples of cosmetic dental procedures.
It’s important to consider your own dental needs and budget when deciding whether to buy dental insurance. If you have a history of dental issues or anticipate needing costly procedures in the near future, dental insurance may be worth the investment. However, if you have good oral health and can afford to pay for routine dental care out of pocket, it may not be necessary.
It’s also good to shop around and compare plans from different providers to find one that best suits your needs and budget.
When looking for a dentist, patients may have different priorities and wants, but some of the most common things that patients may want include:
- Quality of care: Patients may want a dentist who is highly skilled, experienced, and provides high-quality care that meets their dental needs.
- Convenience and availability: Patients may want a dentist who is located near their home or work, has flexible office hours, and can accommodate same-day or next-day appointments.
- Insurance and payment options: Patients may want a dentist who accepts their insurance plan and offers flexible payment options to help make dental care more affordable.
- Office atmosphere and patient comfort: Patients may want a dentist who has a clean, modern, and welcoming office, and makes an effort to create a comfortable and relaxing environment for patients.
- Good communication and patient education: Patients may want a dentist who takes the time to explain procedures, answer questions, and provide clear and concise information.
- Positive patient reviews and testimonials: Patients may want a dentist who has a good reputation and has been recommended by other patients.
- Specialized services: Patients may want a dentist who offers specialized services such as orthodontics, periodontics, endodontics, cosmetic dentistry, and more.
It’s important to keep in mind that everyone has different priorities, so what patients want the most when looking for a dentist can vary. It’s recommended to do research and ask for recommendations from friends, family or colleagues to help find the right dentist for you.
Determining Covered Procedures
Predetermination
Pre-determination is an administrative procedure performed prior to treatment. It is in your best interest to utilize the pre-determination process so you are not surprised with unexpected dental expenses after the work is completed. The predetermination process begins when your dentist submits your proposed treatment plan to the claim office. The claim office will process it and send your dentist an explanation of benefits (EOB) that describes:
- Whether you are eligible for benefits.
- What is considered a covered expense.
- How much is covered by the plan.
- The application of appropriate deductibles, co-payments and/or maximum limitations.
- Your potential out-of-pocket expenses.
- Appropriate alternative treatment options.
Pre-determinations are encouraged for more expensive treatment plans.
ADA FAQ About Dental Plans
Below is a video put together by the American Dental Association which provides a brief overview of some of the more confusing aspects of dental plans.
A brief over of some of the key areas of Dental Plans (courtesy of the ADA)
Frequently Asked Questions
What Does In Network Dental Insurance Mean?
“In-network” dental insurance refers to a provider or dental plan that has contracted with a particular insurance company to provide services to members of that company’s insurance plan at a discounted rate.
When a dental provider or plan is in-network with an insurance company, it means that they have agreed to accept the reimbursement rates and terms set by that insurance company for covered services. This can result in lower costs for the patient, as the insurance company will pay a larger portion of the bill.
When a dental patient visits an in-network provider, the copay or deductible may differ than they would for an out-of-network provider. Additionally, in-network providers are typically required to submit claims to the insurance company for reimbursement on behalf of the patient.
On the other hand, if a dental provider or plan is out-of-network with an insurance company, it means that they do not have a contract with that company, and the patient may have to pay more out of pocket for services, and it can also mean that the insurance company will not cover some or all of the cost of services provided by that provider.
If your dentist is in-network with your dental insurance, they have a legal obligation to accept the terms of the contract they signed with the insurance company, including the reimbursement rates for different procedures. This means that they are obligated to charge you the copayments and deductibles outlined in your plan, and to submit claims to your insurance provider for reimbursement. They are also required to abide by the terms of the contract regarding pre-authorization for certain procedures and to adhere to the insurance company’s guidelines for coding and billing.
What Does Dental Insurance Typically Cover?
Dental insurance typically helps to cover the costs of preventive care and restorative dental care. A dental treatment that would be considered preventative would be a dental cleaning – as would exams, x-rays, fillings, and crowns. Restorative dental care is to restore the functionality and dental health of your teeth and would refer to a dental procedure like a root canal or dental implant.
Some plans may also cover orthodontic treatments, such as braces. The specific services covered and the amount of coverage provided will vary depending on the plan. Many plans have a yearly maximum dental benefit and may require you to pay a portion of the costs, such as a co-pay or deductible. It’s important to review the details of a plan before enrolling to ensure it meets your needs.
What are the Benefits of Seeing an Out of Network Dentist?
Seeing an out-of-network dentist may have the following benefits:
- More flexibility in choosing a provider: If you have a preferred dentist who is not in-network with your insurance plan, you may still be able to see them by paying more out-of-pocket.
- More specialized services: Some out-of-network dentists may specialize in certain procedures or use advanced technology that is not available in-network.
- More personalized care: Some patients may prefer the personalized care and attention that a smaller out-of-network practice may provide, rather than a larger in-network practice.
- Lower costs: In some cases, an out-of-network dentist may charge lower fees than in-network dentists, even after factoring in the additional cost of paying out-of-pocket.
However, it’s also important to consider the potential downsides of seeing an out-of-network dentist, such as higher out-of-pocket costs, and the possibility that your insurance may not cover the costs of treatment at all.
It’s recommended to check the cost and coverage of the out-of-network dentist with your insurance provider and also to compare the costs with in-network dentists to make sure that you are making the best decision for you.
What Is a Missing Tooth Clause in a Dental Plan?
Dental insurance plans typically have a “missing tooth clause”. What this clause stipulates is that the dental insurance plan will not cover the cost to address a missing tooth of any tooth that was missing prior to the patient beginning coverage with the dental insurance plan.
So, if you were missing a tooth (regardless of whether this was due to disease, accident, or extraction), the cost to replace your missing tooth with a dental implant procedure won’t be covered by your dental plan.
At Murphy Dental, we will check your dental insurance plan for a missing tooth and let you if and how this clause is presented in your dental insurance plan. This information is required in many cases before implementing a tooth replacement procedure.
What is the Best Dental Insurance Plan?
It is subjective to determine what is the best dental insurance as it depends on individual needs, budget, and location.
When choosing a dental insurance plan, it’s important to consider the following factors:
- Coverage: Look for a plan that offers the coverage you need for the procedures you expect to have.
- Network: Make sure the plan includes the dentists you want to see and that they are in-network providers.
- Cost: Compare the monthly premium, deductibles, co-pays, and any maximum annual benefits to find a plan that fits your budget.
- Additional benefits: Some plans may offer additional benefits such as orthodontic coverage, or discounts for wellness programs.
- Customer service: It’s important to have a reliable insurance provider that you can contact if you have any questions or issues with your plan.
It’s also recommended to check the insurance providers available in your area, research the plans they offer, and compare the coverage, cost, and other factors before making a decision.
It is also important to keep in mind that dental insurance plans are constantly changing, so it’s a good idea to review your plan and options on an annual basis to ensure that you still have the best plan that suits your needs.
What Dental Insurance Carrier Plans do You Accept at Murphy Dental?
Murphy Dental accepts most dental insurance company plans at our Fort Collins Dental office. We are a participating dentist for many carriers (in network). For more information on your particular plan and how we work with your particular dental coverage, click the appropriate link below:
