Many patients typically don’t know how their dental coverage works, how the claims are being paid or what their plan pays for.
Listed below are 3 ways to help you maximize your dental coverage for the treatment plan we have customized for you:
Benefit Year: Truth be told many dental carriers will run through a Calendar year benefit plan which means that it runs through January 1st until December 31st of each year. Other insurances will run based on when you received your coverage (eg: April 1st – March 31st) It is always good to know what benefit year your insurance runs so that you can utilize the maximum dollar amount that is allowed per year.
Maximum: As noted above, your benefit year will determine when your dollar maximum will restart. Some insurances have a specific dollar amount every year and some do not. For patients that have dollar maximums, it is recommended that you get all necessary treatment done within your benefit year so that when your insurance renews, the new maximum is utilized for any treatment that may be required during that year. Please note that it is always best to do the treatment recommended when it is recommended or shortly after.
Hygiene: Did you know that if you have coverage for a Recall (cleaning) every 6 or 9 months, this does not mean that you are only eligible for a hygiene appointment only every 6 or 9 months. Most plans usually divide your hygiene appointment into two different categories-(1) your recall exam (when the dentist checks for any urgent issues, your polishing, and fluoride which is only covered every 6 or 9 months and (2) the actual removal of tartar or hard deposits (scaling/debridement – the cleaning part of the appointment). However, this does not mean that you are only allowed to come for your hygiene appointment for that time. Your dental carrier will provide you with a specific amount of scaling or root planing units (tartar removal or the actual cleaning) What does that mean? Well this means that your dental plan allows you to have a specific amount of units (4 units, 8 units, 16 units) or some may have no maximum at all. With this being said, you are eligible to have your hygiene treatment done more frequently which is determined by your periodontal (gum) condition which is evaluated during your hygiene appointments at your comprehensive oral examination. The average length of the appointment determines how many units are utilized.
It is important to remember that although you might base your treatment decisions on what your insurance will pay, optimizing your oral health is our number one priority at Credit River Dental Centre. As your oral health partners, we are always available to help you understand the details of your dental coverage so don’t hesitate to ask us if you require clarification.
Keep in mind that your treatment plan is created with your optimal oral health in mind and not around what your insurance covers. Your insurance is only a form of payment for the treatment recommended.
Helpful tip: Give your HR a call and find out if you have a “Health Spending Account” which is an alternative health benefit that provides reimbursement for health related expenses that is over and above your regular benefit plan(s). Your employer will know whether you are eligible for this. In most cases, it is not a benefit that is provided by the same Dental Insurance Company so do not contact your dental insurance company to inquire about this.
Another Helpful tip: Did you know that any treatment not covered by your dental plan may be eligible for tax deduction. Don’t forget to ask us for your tax statement at the end of the year.