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Dental Insurance Coverage

Dental insurance paperworkIf you and your family are covered by dental insurance, the Sevens Dental team wants to help you maximize your benefits. Our team works with dental insurance policies on a daily basis, and we have the knowledge and experience to help you maximize these benefits. If you have questions about your dental insurance policy or how the Sevens Dental team can help you make the most of it, please don’t hesitate to give us a call. We’ll be happy to help.

Basics of Dental Insurance Benefits

Smiling woman in dental chairThere are two main types of dental insurance plans available – health maintenance organizations (HMO) and preferred provider organizations (PPO). Unfortunately, HMO plans have extremely strict guidelines about which providers you can visit and what treatments you can receive. We’re unable to process claims for HMO plans because these policies do not cover out of network dental work in most cases. However, if you have a PPO dental insurance plan, we’re happy to help you with your claims. We are in-network with Delta Dental plans, and we are skilled at maximizing your benefits, even if we’re not an in-network provider with your plan.

In-Network VS Out of Network

Man in dental chair giving thumbs upDental insurance provider networks can be misleading. Unless you have an HMO plan, your dental insurance package is designed to give you the flexibility to choose the best dentist and dental office for your family. Even if a dentist is out of network with your PPO insurance plan, you will not have significantly higher out of pocket costs. Here’s how it works:

  • In-network providers – have a contract with insurers where they agree to charge a specific price for covered treatments. As an example, an insurer may limit preventive checkup fees to $100, and the dentist agrees to this pricing.
  • Your insurer – agrees to cover a percentage of the $100 for your dental checkup. For preventive care, that’s usually between 80% and 100%. At an in-network dentist that means you would end up paying $20 or less.
  • Out of network providers – may not charge the same fees for their services as those outlined by your insurer because they do not have these existing agreements. These fees could be lower. For instance, an out of network dentist may only charge $90 for a preventive checkup. If the fees for service are higher, you will need to pay the difference in price as well as your out of pocket percentage.
  • Out of pocket costs – we work hard to keep our patients’ out of pocket costs low, even if we’re not in-network with their insurer. Our services are well within the average pricing in the area, and any additional cost will be minimal. However, we will also provide clarity in pricing, so you understand exactly what you’ll be expected to pay.
  • Preauthorization – for advanced treatment plans, we will likely recommend a preauthorization. This ensure you will receive the estimated benefits, so there are no surprise fees down the road.

Maximizing Your Insurance & Keeping Smiles Healthy

Smiling couple holding handsThe easiest way to maximize your dental insurance will come as no surprise to our Clayton dental patients. Visiting us every six months for dental checkups will help you prevent the majority of oral health concerns that need advanced, costly treatments. Most insurers cover these preventive appointments between 80% and 100%, so you’ll receive the greatest amount of insurance coverage, lowest out of pocket costs, and minimized risk for serious oral health concerns.

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