I get asked about dental insurance on a daily basis. Most questions are pretty basic and only require a quick response. Others are a little more complicated and I have to do some digging into the patient’s benefit information to get them the answer they deserve. No matter how simple or complicated the scenario is I often get the impression that patients are uncomfortable asking questions in regards to their policy. Insurance is a complicated thing so there’s absolutely no reason to feel bad about asking questions that help you better understand your policy. And if you do have questions, we’re here to help.

One of the more frequently asked questions I receive is in regards to recommendations for a good insurance company. This is a tricky question to answer because there are so many insurance companies available. Those companies each have their own policy types, plans, and levels that offer differing amounts of coverage, often times reflected in the premiums you’ll be paying in each month. My advice on shopping for a new policy is this: ask about the annual maximum, wait periods, annual deductibles, and the coverage (%) that they allow on your treatment (usually specific to the type of dentist your seeing, like orthodontist, periodontist, endodontist, etc.) and compare with other plan types and companies.

As I mentioned, most insurance companies have different plan types, HMO, DMO, PPO, etc. I suggest checking with your insurance company to verify what plan type you have because it can affect your coverage and how your benefits are paid out. If you contact a dental office and ask, “Do you accept Humana insurance?” they’re likely going to say yes and that be the end of the conversation. However, just because a dentist is in-network with the specific company doesn’t mean that they are in-network with each plan type under that company. The easiest way to make certain the dentist will be covered is to simply call your insurance company and provide the doctors name. They should be able to check what networks the dentist is contracted with.

If your dentist is out-of-network, don’t fret right away. Some insurance companies will still provide benefits for that dentist, it will just be paid at a lower percentage and your deductible is probably going to be a little higher. Again, a quick call to your insurance can help you determine this.

Once you figure out which dentists will be covered, your next step is to start figuring out the nitty-gritty. Some important aspects to look into include:

• Annual maximum – this is the limit that your insurance company will pay out towards your dental treatment in a given period. Once that maximum has been reached you’ll be paying out-of-pocket for any other needed treatment.
• Annual deductible – this is the amount that your insurance requires you to pay before they start paying out your benefits. Not all policies have a deductible and it won’t always apply to every procedure. In most cases it will not be applied towards preventative care..
• Waiting period – if you’re obtaining a brand new insurance policy there may be a waiting period, especially on specialists, that will dictate a number of months that you will have to wait before they will begin paying on treatment. This is generally 6 – 12 months..
• Coverage percentages – the percent of the cost that your insurance will pay of charges. For periodontal procedures I’ve seen this go as low 20% and as high as 100%., it just depends on your particular policy. Be aware that this will be a percent up to what you have remaining of your annual maximum. If your maximum has already been reached you will be responsible for 100% of the charges. Also, keep in mind that just because a category (periodontal, endodontic, etc.) is covered doesn’t necessarily mean that the specific procedure you need will be covered. Some insurance companies only pay on non-surgical procedures or have certain procedures that just aren’t covered by the plan. Once you know your treatment you can double check the specific codes which you retrieve from the dental office. .
• Frequency limitations – on the majority of procedures your insurance company will limit the number of times that procedure can be performed or how often. Most companies only allow two dental cleanings per year or one every six months. .

Reviewing your explanation of benefits (EOB) from your insurance can also be a confusing part of handling insurance and claims. If something doesn’t look correct or you don’t understand a portion of it it’s best to contact the insurance company directly before contacting the billing dentist. Your insurance company will be able to look up more specific benefit information than what your dentist has on file for you, helping you get the answers you need faster.