At first, it might seem to be like medical insurance, but actually dental insurance is more like a discount program than it is medical insurance. Dental insurance is designed to pay a portion of the costs associated with dental care. There are several different plans, and several different companies.
The major plans are DHMO’s and PPO’s.
When a dentist signs a contract with a dental insurance company, that provider agrees to accept an insurance fee schedule, which gives their customers a reduced rate for services, the dentist is then known as an In-Network Provider.
MOST plans, will allow 100% of what the insurance fee schedule allows for Preventative work (which includes cleanings along with a few other services), 80% on Basic work (which includes most fillings, root canals and other similar services) and 50% on Major Restorative work (which includes crowns, bridges, dentures and other services alike). That being said; every plan is different. It is not uncommon to see plans that will cover 90% of the fee schedule on Preventative, 70% on Basic and 40% on Major. Some plans only cover preventative services, other plans only cover basic and major services, every plan is different.
Dental insurance plans have a yearly max, most range from $1000 to $3000 with the most common being below $2000.
When a dental office sends in insurance, they receive the amount they will Write-Off for services provided, along with a check for the portion the insurance covers depending on your specific plan. Most dental offices will give an estimation (what we provide is truly an estimation, we never know for sure what your part will be until after we hear back from you insurance company, because of there being so many plans and so many companies, we can’t ever know an exact amount) of what the patient’s portion will be and have you pay at the time of service.
The best way to understand your plan is to read your policy.