Knowing what is and is not covered as part of a dental insurance plan often requires the help of a skilled expert. This person can maneuver the verbiage, benefits, and convoluted details that make it difficult for many patients to understand. When it comes to determining whether a particular service will be paid for (in full or in part) by the insurance company, it helps patients better prepare for treatment and how they plan to pay.
What Insurance Will Cover
Most dental insurance policies only cover preventive and restorative treatment. This is made evident through the coverage breakdown that is often split between in-network vs. out-of-network. Patients with PPO have the option to see someone who is not part of a contract with their insurer; however, it is beneficial for individuals to see a dentist in Naperville who is in-network simply because it often saves them more money.
In choosing an in-network professional, it is common for most plans to follow a similar format that looks something like the following:
- 100% preventive services
- 70-80% minor restorative services
- 50% major restorative services
How these services and percentage breakdowns are determined is up to the insurance company. But no matter how it is divided, patients can expect to save financially when visiting the dentist. Whether it is checkups and cleanings, fluoride treatment, dental X-rays, dental fillings, crowns, tooth extractions, or root canal therapy, most preventive and restorative services will be covered in part by dental insurance.
What Dental Insurance Does Not Cover
When reviewing a particular insurance plan, one type of service that is not typically included is cosmetic care. Veneers, teeth whitening, gum recontouring, and other similar treatments are viewed as “elective procedures” and are not deemed medically necessary. This means the insurance companies do not view them as essential, so there is no available coverage.
Patients who desire to undergo cosmetic treatment of any kind must inquire about alternative payment methods, especially if cash, check, or credit card is not an option. Many dental offices partner with third-party financial institutions like CareCredit and/or offer in-house membership plans that provide discounts on available cosmetic services.
Many dentists encourage their patients to use their available benefits on preventive services simply because it not only minimizes the potential for future problems, but it also allows individuals to better maintain their oral health year-round. No matter if it is preventive or restorative care that is needed, understanding how much insurance will pay can help patients feel more confident about choosing appropriate care.
About Grand Dental – Naperville
At Grand Dental – Naperville, we accept many different insurance plans, and we offer the Grand Advantage Plan for patients and families without private insurance. We are proud to help our patients save time and money through our personalized, collaborative approach to dentistry. To schedule an appointment or ask an insurance question, visit our website or call (630) 576-9970.