Dental Insurance Questions

As a courtesy to all of our patients, Maxwell Creek Family Dental will file any PPO dental insurance.

While we can never guarantee any insurance payment, we hate unexpected surprises! We contact your insurance in advance of your dental appointment in an effort to provide the best treatment estimates possible. Complete the form below and we will contact your insurance company for a complete breakdown of your coverage.

Do You “Take” My Insurance?

The answer is probably! We honor any PPO dental plan that will allow you the freedom to choose your own dental provider. We will also file any insurance on your behalf.

Why Aren’t You A Preferred Provider (PPO) For My Insurance?

Unfortunately, some insurance companies simply do not reimburse enough to cover the cost of dental materials and labor for a procedure. If you’re having a hard time finding a dentist that “takes” your insurance you may have one of those low reimbursement plans. We have found that in many instances, unlike medical insurance, there is a nominal difference in coverage for an “in network” vs. “out of network” dentist.

How Can I Know What My Dental Insurance Will Cover?

Dental insurance generally offsets the cost of treatment, but doesn’t pay for it entirely. On average, dental insurance covers 80-100% of preventative (cleaning, exam and x-rays), up to 80% of restorative (minor fillings) and up to 50% of major work (crown and bridge). Remember, these are not absolutes, but typical industry standards. We do our best to estimate your portion of the payment before you leave our office, but with literally hundreds of insurance companies and thousands of individual plans it’s simply impossible for us to know all of them. That’s why it’s so important for you to know your plan and take charge of your health!

I Have Insurance, So Why Is There An Out-Of-Pocket Expense For My Treatment?

Think about it like this. Pretend that your insurance card is like a debit card. If the procedure is covered, there’s money in the bank to pay for it. You wouldn’t spend money without knowing it’s there waiting on you in your checking account. Insurance is similar. If you know your plan, you will know whether the funds are there to pay for services. Insurance can be really confusing. That’s where we come in. We will take the time to explain your benefits to you as best we can. It’s why we have so much information on our website. We want to educate you so that you can be empowered to take charge of your health and get the full benefit of the insurance you work hard to pay for.

You Told Me I Owed One Amount, But Now I Have A Bill For More. I Thought My Insurance Company Was Supposed To Cover This. What Happened?

We do our best to estimate your out-of-pocket cost before you leave our office. It’s always our goal to be as accurate as possible about what you owe for your visit. As much as we try to be experts on every person’s dental insurance, our real expertise is in dentistry! Please remember that we cater to numerous insurance companies and each company has dozens of plans that an employer can purchase for an employee. In essence, it is impossible to know the exact price for these hundreds of plans. We encourage all patients to be advocates of their own health. But rest assured that we will do everything in our power to make sure you get the full benefit owed to you by your insurance company.

Here are a few reasons why you may have received a bill:

• Your insurance plan paid a lower percentage than expected for the procedure.

• The treatment you needed was not covered by your plan.

• The insurance company decided you did not need a procedure that the doctor identified as necessary. This does not mean it was not necessary.

• You have not met your deductible.

• You have not reached the end of your plan’s waiting period and are ineligible for coverage.

• You’ve maxed out your plan (used up all your benefits on other procedures) and no longer have coverage until the plan resets next year.

How Long Does It Take For An Insurance Claim To Get Paid?

The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.

The Dentist Says I Need A Certain Procedure, But It Isn’t Covered By My Insurance. Why Not, And Isn’t There Some Other Procedure That Would Work Just The Same?

The doctors at Maxwell Creek Family Dentistry diagnose and provide treatment based on what you need, not based on what your insurance covers. Our providers have taken hundreds of hours of continuing education to ensure that they are up to date with the latest procedures, techniques, and materials. Some employers or insurance plans exclude coverage for necessary treatment to reduce their cost. If you’re having trouble affording your dental care, ask us! We offer financing options and if the procedure allows, we can sometimes spread out treatment a little to help you afford it.

What If I Still Have Questions?

We will do our best to answer all of your questions, however, a call to your insurance company, a visit to their website or a meeting with your plan administrator (often your human resources department of your employer) is a great step to fully understanding your insurance coverage. We encourage you to learn as much as you can about your insurance and take charge of your health!

I Want to Take Charge of My Health. What Questions Should I Ask My Insurance Company/Plan Administrator?

Your insurance company can provide you with a breakdown of your dental benefits, but there are six key things to ask about:

Plan Year: Does your insurance follow a normal calendar year? (Jan. 1- Dec. 31) If not, what month and day does your plan year start and end?

Yearly Maximum: What is your annual maximum benefit dollar amount?

Waiting Periods/Age Limitations: Are there any waiting periods for benefits to begin or age limitations?Frequencies: How often does your plan cover cleanings, exams, films, fluoride, and sealants?

Composite Restorations: Does your plan reduce coverage to the rate of old-fashioned amalgam restoration material or does it cover up-to-date composite fillings?

Percent Coverage: What percent does your insurance cover for:

• Preventative/Diagnostic?

• Basic Restorative?

• Major Restorative Treatment and Prosthodontics?

Once you have this information, bring it to us! It will help us understand your plan as well and help us better estimate your out-of-pocket expense.

My Insurance Has Changed. What Should I do?

Most employers distribute new insurance cards occasionally without changing the plan, but sometimes a plan changes without the distribution of new cards or a new group number. It’s always best to ask. If your plan changes or you have a new insurance carrier, call us to let us know about these changes right away. We can update your chart before your next appointment, saving you time waiting and filling out forms in the office. Plus, this will increase the accuracy of your estimated expense the next time you visit us!

I’ve Visited Another Dentist This Year. How Do I Know What My Remaining Benefits Are?

We highly encourage you to call your insurance company and ask. Be sure to let our business staff know about any dental appointments you have had at another office during the benefit year. This will help to ensure you receive your full benefit at upcoming appointments.