Firefly Family Dentistry will submit a dental claim for your appointment to any dental insurance plan that allows you to select your own dentist. We process dental claims on your behalf and do our best to estimate any out-of-pocket costs ahead of your appointment. Every plan is different, please contact our team to discuss your individual plan. We will work with you to maximize your benefits! The treatments recommended by Dr. Sandberg and Dr. Sircher are not created based on your insurance plan. Rather, they are created in the best interest of your individual dental health and successful treatment of your dental needs.
How does dental insurance work?
When the appropriate plan is utilized, Dental insurance can be a great way to help you achieve your dental goals! Our team works hard to understand many dental insurance plans so we can help you decide what plan is best for you and maximize your benefits. It is important to understand dental plans as many can be misleading.
Dental insurance is the opposite of medical insurance. Medical insurance typically requires you to pay up to a deductible amount. After this deductible is met, your medical insurance will often pay a percentage of most procedures based on the treatment you actually need. Whereas dental insurance should be thought of as a “coupon book.” It does not necessarily cover the dental procedures you need. Dental insurance helps offset the cost of predetermined dental procedures based on a contract between the dental insurance company and you (or your employer). These predetermined procedures may not be the dental services that are appropriate for your dental situation.
It is important to remember that dental insurance coverage varies greatly from plan to plan, depending on the level of coverage purchased by you (or your employer). Dental insurance simply helps offset some dental costs. Plans that cost you less often require greater financial contribution by you at the time of service.
Dental insurance plans will provide payment up to a maximum amount each year (typically $500 – $2,000) after you pay a deductible (typically $25-$150 per year per person). This information should be considered when purchasing a plan. For example:
- You purchase a plan that costs you $30 per month. The plan requires you pay a $50 deductible. The plan will provide a dental benefit up to $1,000 annually.
- This plan costs you $360 per year ($30 a month x 12 months = $360), plus the $50 deductible. In total, you are paying $410 for the plan ($360 + $50 = $410).
- Your insurance plan says it will pay up to $1,000 maximum each year.
- The real value of your dental benefit is actually $590 ($1,000 – $410 – $590).
- In reality, this dental plan is only providing you with $180 more than what you paid for the dental coverage ($590 – $410 = $180). Your annual dental benefit is only $180 after you consider your cost to purchase the plan.
Many dental procedures are denied based on “clauses” in your insurance contract. For example, your plan may have a “missing tooth clause.” This means insurance will deny any dental claim to replace a tooth if the tooth was missing prior to purchasing the dental plan. If you are hoping to replace a tooth, this plan will not be helpful. Another common clause is a “waiting period.” This means you will be required to pay into your insurance plan for a set period of time (typically 6 months to one year) before they will pay for services like fillings, crowns, dentures, etc. If you need a dental procedure done now, these plans are also not helpful. There are many of these clauses in insurance contracts and they are typically not clearly outlined when you purchase the plan.
Lastly, many insurance plans will calculate their part of the payment for your dental procedure based on a reduced “fee schedule.” This is a maximum amount of money insurance will pay for a particular service (determined by the contract between your insurance company and you (or your employer), not the actual cost of the dental procedure). For example:
- A dental procedure costs $100. Your insurance may pay 100% of the $100 cost, leaving you with a $0 co-payment.
- Or, they may pay 100% of their reduced fee schedule, for example $60. In this case, the patient will owe the difference of $40 even though the insurance states the procedure is covered at 100% ($100 – $60 = $40).
Our team works hard to understand your dental plan and help you maximize the dental benefits. However, it is ultimately your responsibility to understand your dental plan and you are responsible for any costs not covered by your dental insurance at the time of your dental appointment (unless a payment plan is set up prior to the appointment).
It is important to reach out to our office prior to purchasing dental insurance. We are happy to review the plan with you and help you select the plan that is in your best interest.