Prepare a Questionnaire for Your Dental Insurance Carrier to be Aware of all your Benefits

Your Dental Insurance Carrier

The significance of dental insurance is no less than health insurance and you need to be equally cautious while purchasing dental insurance as you are while buying health insurance. According to the Centers for Disease Control, a great number of people in the U.S hesitate to visit dentists due to the exorbitant cost of dental care. Thus, it is not only necessary for you to have dental insurance but you should also be aware of all the benefits offered by your dental plan. To have complete knowledge and understanding about your dental plan, you should prepare a questionnaire to ask your dental insurance provider, so that you have clarity on your dental plan and you can make the best use of your plan.

Find below a list of questions that you should ask your dental insurance provider to know exactly what will be covered under your plan and what you will be expected to pay for receiving the dental care benefits.

Do dental plans come with a waiting period for major procedures?

In most of the cases, there is no waiting period with dental plans for routine dental care like exams, cleanings, and x-rays, as these services are preventive care services that keep your teeth healthy and help you avoid more costly procedures later on.  However, some dental plans do have waiting periods for some expensive dental procedures like a crown, implant, denture, or a root canal.

What type of teeth cleaning service is covered under the dental plan?

Most of the dental plans provide coverage for two free teeth cleanings in a year. However, you need to know that dental plans cover the cleaning cost only of a healthy-mouth. If you belong to the 75% of the American population with periodontal disease, then you need to check with your dental plan, if it will cover the teeth cleaning or not. You need to specifically ask your dental carrier whether your plan will cover a deep cleaning, scaling, root planing if any of these services are recommended by your dentist. Besides, you should also confirm with your dental insurance carrier whether they will cover your dentist visit for periodontal disease management. You can avail the American dental Association codes from your dentist’s office to provide your dental plan provider to  ensure that you are aware of the exact out-of-pocket costs associated with any dental procedures.

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What type of dental-filling is covered in the plan?

You must check the type of filling your dental plan is going to covered, as there are different types of dental fillings that are recommended by the dentist depending upon your problem. Some of the dental insurance carriers only pay for amalgam or metal fillings but these fillings have mercury in it so many dentists did not prefer to use amalgam fillings and recommend mercury-free white resin composite filling. So you need to check whether the white resin composite filling will be covered under their dental plan or not. If your tooth is decayed more, chances are that your dentist may recommend an inlay or onlay. These are more expensive compared to regular fillings so you need to ask your dental insurance carrier if your plan will provide coverage for these or not.

Is there a clause for a missing tooth in your dental plan?

If you have a missing tooth, then leaving it empty may lead to problems like affecting your bite, loss of bone, and may even cause your facial muscles to sag. So while purchasing a dental plan you need to check that is there a missing tooth clause. Some of the dental insurance carriers consider a missing tooth as a pre-existing condition and so they do not pay for the necessary treatment to restore it. Thus, before buying a dental plan ensure that it covers that treatment cost of a missing tooth.

Will the fees of a dental specialist covered?

You should be aware that your dental insurance carrier may provide a set percentage as coverage for a dental procedure carried out by a general dentist and a different set percentage for the same dental procedure performed by a specialist dentist. Therefore, you need to ask your dental insurance provider about the percentage of the cost that will be covered if you require to visit an endodontist, periodontist, orthodontist, or pediatric dentist.

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Do ask for a copy of the fee schedule?

You should request your dental insurance company to provide you a copy of the fee schedule, which will give you an idea about the fees of different dental procedures. The fee schedule may sometimes have a symbol like an asterisk mark next to the code. To know the exact meaning of the symbol you need to read your plan’s fine print. Generally, the asterisk mark means that there will be out-of-pocket expenses for you.

Do the dental plans come attached with a co-pay or a deductible?

You need to be clear about your co-pays and deductibles before you visit the dentist. Your out-of-pocket cost for your dental plan will depend on the type of dental plan you have purchased. If you have a dental plan that has a low monthly premium, then it is likely that your out-of-pocket costs will be high.

Will relocation affect your out-of-pocket costs?

If you need to relocate due to your job or if you want to change your dental office, then it could affect your out-of-pocket costs for dental care. Generally, the dental insurance company sets the dental care cost which they will pay depending upon the location and so the out-of-pocket costs for dental care vary from one zip code to another. For example, a dental care procedure in New York City will cost more compared to a small town.

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