Dental Insurance – Tappan, NY

How Dental Insurance Works

The main idea behind dental insurance is to ultimately help you save money. That said, not all plans offer the same amount of coverage for the same types of services. This can make it tricky to figure out how much of your costs you can expect your plan to pay for.

Most plans, however, follow the 50%-60%-100% rule. This means that 50% of major treatment costs are covered, 60% of minor treatment costs are covered, and 100% of biannual checkup and cleaning expenses are covered.

Our team can help you determine what your dental insurance plan will and won’t pay for, and will gladly file any claims on your behalf.

What Is the Difference Between Dental & Medical Insurance?

Long story short, medical insurance offers more coverage for unforeseen or emergency medical expenses. Dental insurance, on the other hand, provides more coverage for preventive care. You can see this in the 50%-60%-100% rule, where biannual checkups and cleanings are usually 100% covered. Your dental insurance provider figures that by helping you prevent dental disasters before they happen, both of you can save money on treatment.

Important Dental Insurance Terms

What can also make dental insurance confusing is all the strange terms you might see in the details of your plan! Here are a few you should know:

Annual Maximum. This is the largest dollar amount a dental plan will pay during the year. Basically, you’ll be responsible for any costs that go above the annual maximum.

Coordination of Benefits (COB) or Nonduplication of Benefits. These terms apply to patients covered by more than one dental plan. The benefit payments from all insurers should not add up to more than the total charges. Even though you may have two or more dental benefit plans, there is no guarantee that they will both pay for all of your services.

“Not Dentally Necessary.” Many dental plans state that only procedures that are “medically or dentally necessary” will be covered. If your claim is denied on this basis, however, it does not necessarily mean that the services were in fact not necessary. If your plan rejects a claim because a service was “not dentally necessary,” we can help you make appeal.

Pre-Existing Conditions. A dental plan may not cover conditions that existed before you enrolled in the plan. For example, benefits will not be paid for replacing a tooth that was missing before the effective date of coverage.

Plan Frequency Limitations. A dental plan may limit the number of times it will pay for a certain treatment. But some patients may need a treatment more often to maintain good oral health. For example, a plan might pay for teeth cleaning only twice a year even though the patient needs a cleaning four times a year. We encourage patients to make treatment decisions based on what’s best for their health, not just what is covered by their plan.

In-Network VS. Out-of-Network

Now, dental insurance plans can also be “in-network” or “out-of-network” with any given dental office. PPO plans are most often associated with this. Here are the differences in a nutshell:

In-Network Coverage

If you visit a dentist that’s in-network with your dental insurance plan, then you’ll receive the most coverage possible. At Smile More Dentistry, we accept almost all dental insurance plans, including those with:

Out-of-Network Coverage

If you visit a dentist who’s out-of-network, you may not receive the most coverage possible, but could still very well save money at a comparable rate. In other words, being out-of-network doesn’t mean you can’t use your dental insurance plan. If you really like your out-of-network dentist, know that they’ll still apply any eligible benefits, help you save as much money as possible, and file claims on your behalf.