In general, dental insurance differs from traditional insurance in that dental insurance is more of a supplemental plan that helps you pay for dental procedures. Unlike the medical insurance where if you reach your maximum deductible the insurance pays the rest up to its lifetime limit, dental insurance typically covers percentage of the cost of dental procedure until you reach your yearly maximum. And, did you know that the yearly maximum averaged $1,000 in the 1970’s and has not really changed since.
Below are Frequently Asked Questions (FAQs) regarding dental insurance at Mukilteo Dental Center. If your question is not answered below, please feel free to contact us by phone or email. Also, you may want to refer an article at About.com regarding dental insurances.
Can I come to your office if you are not a preferred provider?
We accept payments from all dental insurances. The payment options and coverages vary greatly within the same company. At Mukiilteo Dental Center, we contact your insurance company for you and get your coverage information. We take this information and help you understand your insurance coverage and the patient responsibility costs for your various treatment options.
What is a PPO? (Preferred Provider Organization)
A PPO is a dental insurance plan that allows you to see any dentist that you want. You may receive different benefits depending on if you see an In-network dentist or an Out-of network dentist. Mukilteo Dental Center is a preferred provider for Washington Dental Service Premier and PPO, Cigna, Premera, and Regence.
Why won’t my insurance company pay for the treatment that my dentist recommends?
At Mukilteo Dental Center, we will recommend the BEST treatment for you, based on our diagnosis and discussion with you. Your insurance company is going to pay for the LEAST costly treatment for them regardless of what is appropriate for your individual needs. We believe that insurance should not dictate treatment. Insurance is only one tool that patients can use to aid them in maintaining their dental health.
Why does my dental plan say it covers cleanings at 100% but my dentist sent me a bill?
If you see an out of network dentist and your insurance company pays 100% of UCR, you may receive a bill from your dentist. UCR means usual, customary and reasonable. This is a fee set by the insurance company and your employer and not a true reflection of fees in your area. If there is a difference between the UCR fee and your dentist’s fee, then you are responsible for the difference. Currently, there is a wide fluctuation between UCR’s of different insurance companies and different plans within each company. This does not mean that your dentist charges too much.
What does dual insurance coverage mean?
If you have dental insurance through your employer and your spouse has dental coverage for you through their employer, then you have dual insurance coverage. Your insurance is considered the primary insurance and your spouse’s is considered the secondary. If your secondary has a standard clause, they will pick up a percentage of what the primary doesn’t. If your secondary has a non-duplication clause, they will not pick up anything left over from the primary.
What is a pre-determination?
A pre-determination is a claim sent to your insurance company telling them what treatment needs to be done. Your insurance then sends back a list of what they would cover for those services. A pre-determination is a great tool to help you and your dentist estimate fees but it is NOT a guarantee of payment and should only be used as a guidelines. Insurance companies will NEVER guarantee payment.
What is a DMO? (Dental Maintenance Organization)
A DMO is a dental insurance plan that requires the subscriber to sign up for a contracted dentist at the time of enrollment. This dentist must direct all of your dental care. If you don’t see this dentist, your insurance will not pay. Mukilteo Dental Center is not a DMO provider for any plans.
At Mukilteo Dental Center, we are more than happy to help you with any questions you may have regarding your dental insurance. We will submit claims on your behalf and help you understand and maximize your dental benefits. Should the need arise, we will assist you with the appeals process. Please feel free to call our office (425-347-4141) and discuss these or any other insurance questions that you may have.