Our Dental Insurance Policy

Understanding The Terminology Of Your Dental Insurance Coverage

Understanding the terminology used in dental insurance can help you make informed decisions:

• Alternative Benefit Provision: Some dental plans may offer alternative benefits if a covered service is not deemed appropriate or necessary. For example, your dental insurance may not cover the full amount for dental implant treatment, but may pay up to the equivalent amount for a dental bridge to go towards your dental implant. Understanding these provisions can be important for making informed decisions about your care.
• Claim Form: A Dental Claim Form is a standardized document used in the dental industry for the submission of dental services and expenses to insurance providers. This form is typically required if patients want to submit a claim to insurance themselves or for Coordination of benefits. Ask your dental clinic if you would like a dental claim form.
• Coinsurance and Copayments: Understand the cost-sharing arrangement. Coinsurance is the percentage of covered expenses you’re responsible for, while a copayment is a fixed amount you pay for a specific service.
• Coordination of Benefits (COB): In cases where an individual is covered by more than one dental insurance plan, coordination of benefits determines how the plans work together to cover the costs, ensuring there is no overpayment.
• Coverage Period (Start and End Dates): Determine the start and end dates of your dental insurance coverage. This is typically an annual period, and benefits may not roll over from one year to the next.
• Dependent Coverage: The inclusion of family members, such as spouses and children, under the dental insurance plan. Plans may have different premium structures and coverage options for dependents.
• Exclusions and Limitations: Review the list of exclusions and limitations in your dental insurance policy. Certain services or conditions may not be covered, so it’s essential to be aware of any restrictions.
• Maximum Benefit Amount: Know the maximum amount your dental insurance will pay for covered services during the coverage period. Once you reach this limit, you will be responsible for any additional costs.
• Preauthorization Requirements: Some dental procedures may require preauthorization from the insurance company before they are covered. Make sure to follow any preauthorization procedures outlined by your plan. Your dental clinic can help you submit a preauthorization request.
• Predetermination of Dental Insurance Benefits: This refers to a process in which a dentist or dental service provider seeks approval or confirmation from the insurance carrier regarding the coverage and benefits for a specific dental treatment or procedure before it is performed. This is often done to obtain clarity on how much the insurance plan will cover and what the patient’s financial responsibility will be.
• Types of Coverage: Familiarize yourself with the types of dental services covered by your insurance. Common categories include preventive, basic/restorative, and major procedures. Each category may have different coverage percentages.
• Waiting Periods: Be aware of any waiting periods for certain dental procedures. Some plans have waiting periods before they cover specific services, especially major procedures.

If you have any further questions regarding our insurance procedures, payment options, or if you require assistance with the claims process or want to know more about the dental services offered at Atlas Dental, please contact us.