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Insurance 101

Dental insurance plans can vary widely; however, we want to help our patient understand their plans by providing the following information.

1. Employer-based Dental Protection: (Example: Delta, BC/BS, etc.)

‚ÄúTypical, Popular, and also Sensible” Dental Insurance Coverage (UCR) programs usually allow people to go to the dental professional of their choice. This type of insurance pays a set percentage of the dentist’s fee, or the plan administrator’s “sensible” or “normal” fee limitation, whichever is less.

Your dental professional may not take part in the network for your insurance coverage. If your dentist does, he or she will submit your case. If not, you may be responsible for paying your dentist as well as submitting your case to Delta Dental or an additional insurance service provider.

Benefits are determined within a “benefit duration”, which is normally for one year (although not necessarily a calendar year). Carefully review your benefits information to ensure that you understand when you may be approaching your deductible repayments or benefit maximums.

Maximums

Many dental plans have an annual maximum. This is the maximum amount a dental plan will pay towards the expense of oral treatment within a particular benefit period (typically January through December).

Deductibles

Many dental plans contain an insurance deductible. It works similar to your automobile insurance coverage. During a benefit period, you will be responsible for a specified percentage of the cost prior to the insurance company coverage kicking in. Your plan information will detail how your insurance deductible works. Some plans differ in this area. For example, some dental plans will apply the deductible for diagnostic or precautionary treatments, while others will not.

Coinsurance

Numerous insurance plans have a co-insurance stipulation. This means that the plan pays a fixed percentage of the price of your therapy, and you pay the difference. What you pay is called the co-insurance, as it pertains to your out-of-pocket cost. It is paid after the deductible has been met.

2. Table or Schedule of Allowance Dental programs (Ex-spouse: Humana, Careington)

Table or Schedule of Allowance programs identify a listing of protected benefits with a designated dollar amount. This amount represents how much the plan will pay for those services that are covered, regardless of the fee charged by the dentist. The difference between the permitted fee and the dentist’s fee is billed to the patient.

3. State Based Dental Insurance Coverage (Ex-spouse: UCare, Medica/MHCP)

Call the MN Department of Person Solutions to see if you qualify for state assisted dental insurance. If you qualify for coverage:

You may be required to pay:
(1) A regular monthly costs
(2) Copays for certain treatments
(3) A portion of your income towards your health care costs
How much you pay relies on the program you qualify for, your house size, revenue, age, maternity status, as well as if you are blind or have an impairment. Expectant females and children generally do not pay anything.

With both MHCP and UCare, the patient will NOT be required to pay any type of copays at the oral workplace. Usually, benefits will consist of 2 oral cleanings and one collection of x-rays per year. Crowns are not a covered benefit for individuals age 21 or older.

4. Fee for Service The patient is responsible for the entire cost of treatment. There are no cases to be submitted and, no insurance policy restrictions. We have several financing alternatives for Fee for Service individuals:

(A) CareCredit
(B) Providing Club
(C) CAPS discount rate plan
(D) Cash/Check/Credit Card

Please call our office for more details.

5. https://www.fairhealthconsumer.org/

This web link will help you in estimating the cost of dental treatment, including the price in your area.

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