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24Mar2015

From The Experts: Danielle Answers Your Questions About Dental Insurance

DO YOU HAVE QUESTIONS ABOUT DENTAL INSURANCE? Here’s some information that will help you get the most out of your plan.

How Dental Insurance Differs From Medical Insurance

Regular medical insurance is designed to help with major, expensive illnesses and provides minimal help with preventative care. Dental insurance usually works the opposite way. It typically covers a large percentage of preventive care (such as your regularly scheduled checkups and cleanings).

You get the most out of your dental insurance when you take preventive measures. It’s also what’s best for your smile, of course!

Danielle Answers Some Commonly Asked Questions…

Insurance is a complex subject, so major props to Danielle, who takes care of it here in our office. We invited her to answer some questions that we knew you’d find helpful.

“Which insurance companies do you work with/which networks are you a preferred provider with?”

We will work with ALL insurance companies! A big misconception is that you MUST go to an in-network dentist. For most insurance policies this is not the case. This allows you to take advantage of the benefits through your policy at the dentist of your choosing. The difference between in-network and out-of-network cost lies in the insurance companies allowed amounts and the actual charged amount by your dentist office. For example, your dentist office charges $80 for a regular cleaning, your insurance pays 100% of cleanings which actually means 100% of their “allowed” amount, which could be $75. That leaves $5 in out-of-pocket expenses. Allowed amounts can vary widely and are often determined by an agreement between your employer and the insurance company.

Note! We’re A Preferred Provider For…

We are a preferred provider for Health Resources (HRI), Dental Health Options. Health Resources is an Indiana company and many large employers, such as Forest River, Goshen College, and Wieland Designs utilize them to provide their employees with exceptional dental health options!

“What’s the process for processing claims in your office?”

I will electronically file your claims from our office. No out-sourcing and no snail mail! This allows me to have a fingering on the pulse of every insurance company in which our patients are subscribers. Electronic filing means I get claims paid faster and I am able to take care of denials or inquires in real time. I am your advocate with your insurance company and will do everything in my power to get your claims paid.

In our office we will also file medical insurance claims for sleep apnea devices. Many dentist offices won’t even attempt to tread this treacherous water but we have had great success in getting paid claims and have been successful in obtaining gap waivers from insurance companies that allow us to be considered as an in-network provider for the insurance company.

“For patients who are making decisions about signing up for dental insurance right now, what should they know?”

Call an expert!

I cannot even express enough the importance of knowing what you’re getting! If you are looking on the exchange (“Obama Care”), be sure that the policy you are getting is an adult policy! I can’t tell you how many patients have handed us insurance cards and said “The medical policy said it had dental coverage” only to find out the dental coverage is only for a child!

Also, many policies on the exchange have “fee based” coverage. This means that the policy says “100% Preventative coverage, 100% Basic Coverage, and 80-100% Major coverage based on maximum allowed amount. Allowed amounts on these policies are ridiculously low! That cleaning we talked about earlier will likely have an allowed amount of $20!

Medicare Supplemental policies need to be carefully looked at as well. I see seniors being taken advantage of, with policies they can’t use, more than any other group.

Most employer provided dental insurance policies are fairly easy to navigate and understand, in these cases talking to co-workers who have the policy can be a huge asset.

Here at Stutsman Dentistry we want you to get the most out of your policy and to ensure our patients are not being taken advantage of. Please don’t hesitate to give me a call, I can give you a comprehensive overview of your policy, even if you are not a current patient.

Let Us Know If You Have Other Questions

We’re here to help. If you’re considering an insurance policy, you can come to us with questions. And if you’re wondering how you can best put your existing insurance policy to work, talk to us!

Thanks for your trust in our practice!

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