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Dental Insurance IS NOT THE SAME as Health Insurance

Dental Insurance IS NOT THE SAME as Health Insurance

Feb 21, 2020

Many people. maybe even most people, believe that Covington dental insurance works just like health insurance. Generally speaking, that’s just not the case. Most Covington dental insurance plans are really a Covington dental discount plan, and not co-insurance the way we’ve grown up knowing health insurance to work.

Each dental insurance carrier, like Humana or Delta, has a fee schedule that the doctor is required to accept if they want to be included on that carrier’s list of approved doctors. Every carrier’s accepted fee is different. For example, a regular healthy dental cleaning may cost $200 in an all cash office. When an office accepts insurance, the amount for that cleaning depends on the insurance carrier you have – maybe Humana allows $165, Delta allows $145, Ameritas allows $125, etc. You have a co-pay that your carrier requires and that is all that you would pay. THESE NUMBERS ARE NOT CORRECT, BUT ARE BEING USED FOR DEMONSTRATION PURPOSES ONLY.

Most Covington dental insurance plans will not cover very much treatment beyond the regular Covington dental maintenance, but most other treatments DO have an agreed upon fee. For example, if you need a deep cleaning, there may be no coverage for that besides the previously agreed upon fee schedule between your dental insurance carrier and the dentist. You may have some coverage for that and would then owe the difference in the treatment cost and the coverage amount.

Covington dental insurance often increases in coverage the longer you have it. The first year may have minimal coverage for major treatment with this coverage increasing the longer you keep the same dental plan and carrier. With traditional health insurance you are covered for almost everything immediately, but with dental insurance the coverages generally get better with time.
When considering dental insurance, you may consider the monthly cost of the dental plan vs. paying cash at the dentist. If a dentist knows that you have dental insurance with a certain carrier, the dentist can not accept a price different from the agreed upon fee schedule. With dental insurance, the dentist completes the treatment then submits the documentation to the insurance company and waits for the carrier to pay that claim. With a cash patient, the dentist completes the treatment, receives the cash and that’s the end of that transaction with no waiting. Remember, cash is king in most financial transactions.

Here are some common questions we hear in relation to insurance:

  1. I’ve been diagnosed as having periodontal disease, why can’t I get a regular cleaning?
    A: The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone. When there are some signs of gum disease, it must be diagnosed by a dental professional. This cannot be removed with regular brushing or standard dental cleanings, so at the point of a gum disease diagnosis, a dental deep cleaning is absolutely necessary.
  2. Why do I have to take x-rays?
    A: Dental X-rays (radiographs) are images of your teeth that your dentist and hygienist uses to evaluate your oral health. These X-rays are used with low levels of radiation to capture images of the interior of your teeth and gums. This will help your dentist to identify problems, like cavities, tooth decay, and impacted teeth
  3. Q: Do you accept Medicaid, Wellcare, or Peachstate?
    A: Our office is not a provider for Medicaid or any of the state funded dental insurance plans.
  4. What is the difference between PPO and HMO?
    A: HMOs tend to be more affordable, but you’ll usually get less coverage and more restrictions. PPOs are more flexible and provide greater coverage; Participants insured with a dental PPO insurance plan are responsible for paying their deductible before receiving any reimbursement.
  5. Do you accept my insurance?
    A: Our office accepts most PPO dental insurance plans and we also offer an in office discount plan.
  6. How much as an extraction?
    A: Because the needs of every patient vary, a range of an extraction starts at $221-$419.00. That cost typically does not include the exam and any necessary diagnostic x-rays.
  7. I was diagnosed as needing a root canal, crown and build up on my tooth, why can’t I just get a filling?
    A: A cavity is decay nearer to the surface of the tooth, not in the root, and can be restored with a filling. When a root canal is needed, there is severe decay and an infection deep in the tooth pulp that will become worse over time.
  8. Do you have payment plans?
    A: Our office does offer financing through 3rd party providers that allows the flexibility to extend your payments up to 24 months pending credit approval.

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