Dolton residents guide to dental insurance: Maximum use of benefits
Dental insurance can save you thousands of dollars, and enable you to receive treatment that you may otherwise be unable to afford. However, it is completely worthless if you don’t use it. Dr. Dietrich wants every patient to enjoy the maximum benefits of his or her insurance coverage. Because using up your benefits is not as simple as it sounds, he is happy to work with you in scheduling procedures, and help you better understand your policy.
The seasons of insurance
The first thing that you need to know is the duration of your benefit period. For most people, it is January through December, but some policies deviate from the normal cycle. Assuming that your benefits are on an annual schedule, you lose any remaining benefits as of Dec. 31, and a new cycle begins.
As of New Year’s Day (or the first day of your benefit period), your deductible is reset. That means you will have to pay 100 percent of costs for any procedure until you have reached the total of your deductible. Some plans handle deductibles differently, so it is important to check the details of your policy. Preventive and diagnostic services may count towards the deductible, but not always.
The sky isn’t the limit
Insurance companies put restrictions and limitations on their portion of costs. Your plan might pay the full cost of diagnostics and preventive care, but it will only pay a percentage of other services, which is typically lower for major procedures. For example, your provider might pay 100 percent of a cleaning, 75 percent of a filling, and 50 percent of a crown. Additionally, some procedures are covered only if they are deemed necessary. For example, your insurance probably covers part of the cost of a crown for restoring a damaged or decayed tooth, but it probably would not pay anything on a crown placed for purely cosmetic reasons.
The most notable way that your coverage is limited is the annual cap on insurance payments. Few plans are unlimited. Your policy almost certainly includes a clause limiting the total amount that will be paid in a benefit cycle. If your teeth are healthy, this amount is probably sufficient. However, if you need extensive dental work, the total may exceed the limit, leaving you with a larger bill. This can often be avoided by spreading the treatment plan over two or more billing cycles. We may begin treatment late in the year, until your maximum has been reached, and then resume in January. Sometime multi-phase treatments can be spaced several months apart, to pace the treatment with your plan.
Maximizing insurance benefits is just one of the ways that Dr. Dietrich makes dental care affordable for residents of Dolton and surrounding communities. Call (708) 576-1900 and schedule an appointment at Pleasant Dental®.
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