Dental plan coverage?

Question

Just a quick general knowledge question. Someone at work here is questioning our dental plan becuase she needs a root canal. I personally rarely use the health or dental coverage. I was under the impression that most dental plans paid a percentage of the cost of dental work up to a predetermined out of pocket amount for the insured. For example, the insured may have to pay 60% of the cost of dental work during the year up to a total out of pocket expense of $2,500, after that , all is covered. Someone else at work is saying it is the opposite. The insurance co. will pay their percentage up to a predetermined amount and then it's all on the insured. How are most policies structured?

Answer 1

O.k.,this is how dental insurances work.Usually they separate the services on:Preventative care(usually covered at 100% with no deductible);Basic care(usually covered at 80%) and Major care(usually covered at 50 or 60%).If you need any services that fall under the Basic and Major category then you will usually pay yearly deductible and on top of that the percentage that it is not paid by your insurance.There is a certain amount the insurance will pay per year,for example from $1000 to $2000 or more.Once they pay all that it means that you have reached your yearly maximum and if you decide to have any more dental work done after that ,the cost will be out of your pocket,but if wait for your new benefit year ,then you will have another 1000 or 2000 dollars available.
This information is general,because I have seen insurances with no deductible,who cover everything 100% or some who have unlimited coverage.Very important is also to make sure that the dentist you are going to visit is in the network with your insurance,cause if he is not,you might not be covered or might have to pay more out of pocket!Well,I hope I was helpful,I deal with dental insurances all day at work,so you can trust me!:))

Answer 2

Most plans pay 100% of preventive. Then you usually have a deductible then they pay a percentage of the fees up to a max usually 1,000 to 1,500. If your max is reached you are responsible for the balance. I work for an oral surgeon and we ask 20% the day of surgery due to most insurances pay 80% until the max is met. You also need to make sure you go to someone in the network or the benefits will be less or not at all.

Always call the insurance co to find out what they will pay because it is the insured responsibility.

Hope this helps!!

Answer 3

Even if you had gone to an "in network" dentist, it is very possible that a root canal would not have been covered by your insurance. Under DMO (or DHMO), in network dentists are given a bulk annual payment to cover everything they do for covered patients during that year. As a result, it's OK for patients just needing an infrequent check up or cleaning. But whether something more expensive is covered is solely at the discretion of the dentist. Know the terms of your insurance. When in doubt, ask ahead of time. Having to pay is a great learning experience. Sorry.

Answer 4

Mine pays a percentage after a deductible, but I'm not aware that there is an out of pocket limit. They pay all of regular visits. I know why medical plan works the way you describe. It wouldn't surprise me if a dental plan worked the way your coworker describes.

Just for reference.

Answer 5

most dental work these days have a pretty hefty price tag......fortunately, there are now discount benefits available where you can save from 25% to 80%--it's like having a grocery store discount card and they also come with additional discounts on vision, chiropractic and prescription at no additional charge.

You can see one at www.mybenefitsplus.com put 40456126 in the code box and you can search other sites

Answer 6

Lisa needs braces....dental plan!...Lisa needs braces....dental plan!...Lisa needs braces...dental plan!