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Navigating Dental Insurance: Key Points to Consider
Selecting the best dental insurance can be quite challenging. This is very evident when it comes to a number of plans and clauses, and it will be quite important to take time and evaluate the whole process before making a decision. To assist you, here is an overview of the basic aspects that you need to know about dental insurance.
Understanding Basic Coverage
For your non-emergency dental checkups, cleanings, X-rays, and examinations alone, plans such as Guardian can suffice. However, when you require more complex operations, including dental plates, bridges, or procedures after tooth extraction, then you have to take into consideration the missing tooth clause (MTC). It will state that any treatment affecting the teeth before insurance was secured will not be paid for by the insurance company. Typically, the MTC becomes permanent in most jurisdictions, but in some places, it remains in force for only 1 year.
Replacement Clauses and Coverage Caps
When looking for dental insurance for crowns, dentures, fillings, inlay, onlay, bridge, or implants, always keep the replacement clause in mind. For instance, in the case of Guardian, there is a replacement clause of 10 years for some procedures. Further, there is a lifetime limit attached to most implant coverage. Some plans, for example, may provide not more than $1000 of reimbursement for the costs of implants, no matter how many years you have been continuously insured.
Waiting Periods and Service Coverage
Another mistake that people make while buying dental insurance is to assume that some services will be covered as soon as they take up the insurance policy. It is important to note that waiting periods are still a common occurrence in most dental PPOs. Periodontal examinations and initial dental cleanings do not have a waiting period as they are considered preventive services.
There may be a waiting time of up to six months for procedures that are regarded as routine, including fillings and simple tooth extractions. Some of the important services, such as periodontal treatments, endodontic treatments, oral surgeries, and major restorative treatments like crowns and dentures, and implants, may take at least 1 year waiting period.
Importance of Preauthorization
It is always advisable to seek preauthorization before you undertake any major dental procedure, particularly one that could attract a hefty bill. This means that when you take the insurance policy, you get to know what is going to be covered, what you will have to pay from your pocket, and what the insurance company will pay. Do not continue with the service until the preauthorization is completed.
Evaluating Your Needs
Look at it from the aspect of your dental history and current needs, as well as your future expectations about your teeth. For those of you who have a family, there is a likelihood that a more expansive plan is required. Prepare a positive-swinging and negative-swinging checklist that can help you weigh your options. Key questions to consider include:
- What is the annual maximum limit?
- What is the waiting period, specifically?
- What is the difference in coverage between in-network and out-of-network visits?
Importance of Preauthorization
Dental insurance mainly focuses on general care, which involves regular visits to the dentist, cleaning, and radiology. Proper dental checkups will help avoid more elaborate procedures, which are expensive and painful. Possessing insurance may keep you compliant with these preventive measures.
When it comes to insurance, we know how convoluted it can be, and that is why we are here to assist you at Smiley Dental in Fairhaven. Our staff will make sure that you receive exceptional care and help you understand your insurance policies.
To avoid any misunderstanding regarding the coverage, please talk to our staff before going through any extensive operations. We suggest contacting your insurer and filing a preauthorization request to determine your insurance coverage and associated fees.
Among the factors, dental insurance plans have different clauses and coverage that make it important to choose the right dental insurance. At Smiley Dental in Fairhaven, we endeavor to ensure you make the right choices for your dental healthcare. Call us today for help with all of your insurance solutions and to set up your next appointment!