Understanding Your Dental Insurance

dental insurance claims forms

With the end of the year just weeks away, it’s important that you understand how your dental insurance works so that you can take advantage of any remaining benefits if you need work done. While every insurance policy is different, most of them have a few characteristics in common. If you have questions about your particular plan, please call our office and one of our office staff members can help you decipher the terms of your policy.

Annual Maximum

Most PPO (preferred provider organization) and POS (point of service) plans include an annual maximum. This is the highest dollar amount that the insurance company will be responsible for in any given year. In almost every case, this is a calendar year; in a few cases, however, the maximum runs by fiscal year or beginning in the month that your policy began.

If you are getting close to your maximum and you still need work done in 2014, please let our office staff know! In some cases, it might be prudent to wait to have non-urgent work done after the new year so you can apply the fees toward your 2015 maximum. On the other hand, if you still have a lot of benefit dollars left, it’s usually better to get your necessary work done now, before the end of the year, if possible. Remember to call us now to schedule an appointment, as the holidays and the end of the year is a busy time in our office!

Annual Deductible

Many, but not all, plans also have an annual deductible. This is the dollar amount that you must pay before any insurance money is paid out. In many cases, your routine cleanings and xrays are not included in the deductible, but some plans do require you to pay your deductible even before preventative and diagnostic care.

By now, most of our patients have met their deductibles for the year. If you haven’t, and you need to have work done, you will need to pay your 2014 deductible. If you need more work done after the new year, you’ll need to pay it again. This is another consideration to keep in mind when deciding whether to schedule non-urgent or optional work now or in a couple of months.

New Plans

Many dental plans renew on January 1, and many employers choose this time to change their employees’ policies, if they were planning to change. Be sure to ask your employer whether your dental insurance is remaining the same. If it’s not, find out what the new plan will be, and talk to our office staff as soon as possible. If we are not an in-network provider, your fees may go up in the coming year. Alternately, it’s possible that we will now be an in-network provider. Another possibility is that your fee schedule or coinsurance might be going up or down; this, too, will impact the fees you will need to pay next year.

Dental insurance can be confusing, but our office staff is familiar with the most popular plans in our area. Give us a call if you need help navigating your dental insurance policy as we head into the new year.