Co-payments, deductibles, pre-determinations, insurance benefits limits … what does this all mean? Although your dental insurance benefits can offer you significant savings, your dental insurance policy can also be difficult to understand. In today’s dental blog, our Calgary dentist explains some of the more common terms used in a dental insurance policy and how they affect your dental benefits.
KNOW YOUR DENTAL INSURANCE POLICY LIMITS
When it comes to dental insurance plans, patients should be aware that every plan is different and therefore patients should always refer to the particulars of their own dental insurance policy. Having said that, a common feature of many dental plans is an annual policy limit. This means that, for a particular fiscal year, your dental insurance plan will only pay benefits up to a certain dollar amount. Anything beyond that dollar amount charged by your Calgary dentist office will not be covered by your dental insurance plan.
If your policy has an annual spending limit, prior to proceeding with dental treatment, it is a good idea to check with your dental insurance company to determine whether you are approaching your annual limit. Although our Calgary dentist does not recommend that your dental treatment be governed by your dental insurance benefits, it is certainly understandable that you want to maximize the use of your dental benefits, particularly if it is close to the end of your fiscal year and your Calgary dentist advises you that the treatment can be safely completed at the start of a new fiscal year when your spending limit resets.
UNDERSTAND YOUR DENTAL INSURANCE CO-PAYMENT
Most dental insurance companies require that the patient pay a portion of their Calgary dentist fee, known as the co-payment. The amount of the co-payment varies amongst dental insurance plans as well as dental procedures.
Some dental insurance plans will pay 100% of either the Calgary dentist’s fees or the fees set by the dental insurance company in their own dental fee guide. Most insurance plans, however, will only cover a portion of the Calgary dentist fees based upon the fee guide set by the individual dental insurance company, and the amount of coverage will vary according to the type of procedure being done.
For instance, it is common for a Calgary dentist’s fees for preventative types of dental treatment, including scaling and dental examinations, to be covered at a rate of between 70 and 100%. This means that the patient is responsible for paying the balance of the Calgary dentist fees after payment by the dental insurer. It’s important to remember that this percentage payment is typically calculated according to the dental insurance company’s fee guide, which also varies amongst insurance companies and individual dental plans.
DENTAL INSURANCE BENEFITS DO NOT ACCUMULATE
Most dental insurance plans do not roll over from year to year. This means that, if you do not use your dental insurance benefits at your Calgary dentist office within your insurance plan’s fiscal year, you will lose them. This is another reason to make sure you are familiar with the terms of your dental insurance policy, including the amount of coverage you are entitled to. You have already paid for those benefits, so you may as well use them!
AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE
You have undoubtedly heard this many times but it really is true, especially when it comes to your dental health. Visiting your Calgary dentist twice per year for dental cleanings and examinations can help keep your teeth, gums and mouth healthy by addressing small issues before they become larger, more expensive problems that require more extensive dental intervention. And don’t forget that preventative dentist appointments, which include such procedures as dental x-rays, cleanings and dentist examinations, are typically covered by your dental insurance plan at a higher rate (typically between 70 and 100% of the dental insurer’s fee guide) so it makes sense both financially and for your health to use as many benefits as you may need or may be recommended for you during the year.
YOU CAN PRE-DETERMINE YOUR DENTAL COVERAGE
If you are unsure what your dental insurance benefits will cover for any particular dental procedure, you can always ask your Calgary dentist office to pre-determine your dental insurance coverage. It’s important to ask your Calgary dentist office to pre-determine your coverage well ahead of your anticipated dental treatment as, although some procedures such as dental cleanings can be pre-determined on the day of your Calgary dental visit, other procedures such as crowns, bridges, dental implants and more complicated dental work may take several weeks to receive a pre-determination back from your dental insurance company.
BOOK YOUR APPOINTMENT WITH OUR CALGARY DENTIST TODAY!
With the new year just around the corner, this is a good time to revisit the particulars of your dental insurance plan and ensure that you are taking full advantage of your dental insurance benefits at your Calgary dentist office before your dental insurance benefits expire. If you require assistance from our Calgary dentist office to help you understand your dental insurance policy and what you may be entitled to, please call our office and one of our friendly and helpful team members would be happy to assist you in any way they can.
At our Calgary dentist office, we understand that maximizing your dental benefits makes both financial and health sense to our patients. If you are contemplating proceeding with any recommended dental treatment and require assistance in understanding your dental benefits or, if you would like a pre-determination completed, we invite you to call our Calgary dentist office today. Our team at Advance Your Health always does our best to find the answers that you are looking for so that your dental appointment is as stress-free and convenient as possible. Call us today at 403.283.4252. We’re here to help.
This blog post written by our Calgary dentist, Dr. Dirk Thompson, D.D.S., is for informational purposes only. It is not to be taken or used as a substitute for dental, medical or other professional advice, treatment or diagnosis. Always ask your dentist, physician or other healthcare professional for advice before altering your diet or healthcare routine. Individual patient needs and oral healthcare concerns vary so please consult your dentist for more information about your specific dental health requirements.\
Copyright 2021: Dirk A. Thompson Professional Corporation operating as Advance Your Health Dental. Dr. Dirk A. Thompson, D.D.S., is a general dentist in Calgary, Alberta, Canada.
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