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How Does Dental Insurance Work?


   
   
First, let’s talk about how insurance companies decide what they will and will not cover. Generally speaking, most insurances will cover 50%- 80% of the total treatment cost. For major procedures such as crowns or bridges, most plans will only cover 50% of the total treatment.


In general, insurances will pay for a full cleaning every six months. You are ultimately responsible for paying the entire fee for any accepted dental treatment, regardless of your insurance coverage. This means that you are responsible for any charges that your insurance does not pay for. Also, Keep in mind that benefits cannot be saved and carried over into the next year.


We strive to personalize every treatment plan based on your situation. Our dentist will always form a treatment based on your overall oral health, not just temporarily relieving discomfort. In other words, we will treat the cause not the symptoms.


We do not allow your insurance to dictate how we treat you. We are happy to help you receive the maximum benefits that are available to you; although whether or not your optimal treatment plan is covered is between you and your insurance. We can request a list of what your insurance will cover prior to your treatment, however you make the final decision on your treatment plan.


It is very important to keep track of your insurance claims, because without them, you would be responsible to pay for the full amount of any treatment. Here are some things to think about when depending on an insurance benefit claim.

 

  1. We file dental insurance for our patients as a courtesy it is not our responsibility.

  2. Patients are responsible for notifying us of any changes in coverage

  3. If your claim was not accepted the first time, there was most likely an error with your insurance not our staff. We gladly file claims for a second time, however if there is still no response, it is the patient's responsibility to investigate why. Failure to do so in a timely manner may result in a late fee and inability to make future appointments.


There are many things we can help you with such as finding a list of benefits covered by your plan or file a claim, however we do have limits. Here are three things we CANNOT do:

  1. We cannot alter the date of your treatment.
  2. We cannot submit a claim for more than the actual fee.
  3. We cannot submit a claim for procedures that have not been performed.

Furthermore, we have no right to negotiate with your insurance about any reimbursements or dental expenses. Your insurance has no payment obligation beyond that of your annual maximum.


Review

Here is a review of the points we talked about. If you still have questions, feel free to ask our staff or call your insurance company for more information.

 

  • Every plan is unique, therefore you must be in contact with your insurance to be confident about what your benefits are. We are more than happy to request a list of benefits from your insurance.

  • We are here to treat the cause of your symptoms, not to just relieve temporary discomfort. Treatment plans are personalized and may not always be covered by insurance.

  • We file claims as a courtesy, not as a requirement. It is the patient's responsibility to investigate and resolve any issues with claiming benefits.

  • The patient is ultimately responsible for any remaining balances after a claim has been filed. Failure to resolve any outstanding balance may result in a late fee or inability to make future appointments.

 

This break down is meant to provide an overview of the process of Dental Insurance, it does not include absolutely everything you need to know concerning insurance, but it is a great start to get a better understanding of insurance coverages. This information is not be used as concrete evidence, but rather to give you a general idea of the process.

 

 



 

Patient Resource Center

3500 Professional Cir
Martinez, GA 30907
(706) 860-9882