At 1st Family Dental, we believe surprises can be fun and exciting, but not when it comes to your dental insurance.

We believe all of our patients have a right to understand the fundamentals of purchasing and utilizing the different types of insurance coverage.

In Part 1 of our series, we reviewed the basics about some of the different types of insurance available on the market.  In Part 2, we curated a list of questions for you to ask yourself when preparing to shop for coverage, as well as some critical questions to ask your insurance carrier to better understand the benefits available to you in your policy.

Part 3 of this informational series focuses on questions to ask your current or potential dental provider (meaning, your dentist or dental office), to ensure they can help you to maximize your insurance benefits and ensure the treatment and claims process is as simple and straightforward as possible.

Questions to Ask Your Dental Provider:

— Do you accept my dental insurance coverage?  This is a great question to start with.  Most dental practices can list the types of insurance plans they accept.  If you have a HMO plan, your dental provider may want to confirm with you that you have listed them as your preferred dentist.  Also, if you have changed insurance plans, we always recommend checking with your dental office to inform them of the new plan and review coverage.

— Do you pre-verify my insurance benefits before my appointment?  Contacting policy carriers to verify insurance benefits can take quite a bit of time.  Pre-verifying insurance coverage is not only a courtesy to help reduce waiting time at your appointment, it also means your dental provider is taking the time and effort to review your coverage ahead of time.

— Do you provide treatment plan estimates?  Your dental provider should be able to tell you what procedures and services are covered, and at what expected rate, and estimate any copays or potential out-of-pocket expenses prior to providing a service, particularly for major procedures.  You should always be comfortably in control of your dental care.  If you have any questions or concerns, we recommend that you ask to speak with the insurance expert before starting any treatment.

— Do you file insurance claims with my carrier and follow up on those claims?  Many dental practices file insurance claims on behalf of the patient and follow up on the claims to make sure the insurance carrier responds.  However, some do not, and patients may be required to pay out of pocket and then file their own claims with the insurance carrier for reimbursement.

— Do you provide specialty treatment in-house, such as molar root canals and wisdom tooth extractions, or do you usually refer to a specialist?   Some dental providers may be able to provide specialty treatments without the need for a referral, which can save both time and out of pocket expense.

— What can you do to maximize my insurance benefits and minimize my out-of-pocket expenses?  Your dental care provider should be able to discuss strategies with you that can help you get the most out of your dental insurance.

Maximizing your Dental Insurance Coverage

It is very important to note that dental insurance coverage is not guaranteed.  After a procedure is performed and the insurance claim is submitted, your insurance carrier may cover a procedure at a lesser rate, and some procedures and services are not covered at all.  This is under the sole discretion of the insurance company.

However, your dental provider should be able to provide you with strategies to help maximize your benefits.  Ask your dental care provider if they offer any of the following options:

Does your dental care provider monitor your benefit levels and remind you to use any remaining benefits before they expire?

Will you provider recommend submitting a pre-authorization for certain procedures in order to provide you with a more confident estimate of what you can expect your policy to cover?

Will your provider review your comprehensive treatment plan with you, and recommend phasing and prioritizing treatment across the term of the policy to address your dental health needs while maximizing your benefits and reducing out of pocket expenses?

If a procedure is not covered by my insurance or we expect out of pocket expenses, how can your provider help to make your dental care fit your budget?  Ask your provider if they offer discounts on procedures, offer interest-free or low-interest financing, or provide other payment options.

Ask about guarantees on work and services.  Ask your dental provider if they offer guarantees on services and procedures such as fillings, crowns, dental implants, and dentures.  With proper home care and maintenance, as well as regular visits to the dentist for checkups, many dental restorations can last a very long time.  However, occasionally, work may need to be re-done or repaired.  Ask your dental provider if they provide quality guarantees on any dental procedures.

As always, we welcome questions, comments and suggestions.  Please feel free to leave a message below, or send us an email at email@1fd.org.