Dental Insurance and Major Dental Work: What is Generally Covered?
Costs for dental treatment are usually very high and unless you have some sort of dental coverage, it is very hard to pay fully for treatments. The most popular option is dental insurance. Dental insurance works like any other insurance plan. You pay a fixed monthly premium and in case you need a treatment, you file a claim and the company pays fully or partially for your dental procedure.
A dental insurance plan generally covers:
• Preventative procedures:
This includes routine visits to the dentist for treatments like cleaning and examinations. Some companies will also include x-rays, dental sealants and fluoride treatments in preventative procedures. However, some may not, so it is important to check.
• Basic or Restorative procedures:
This category includes procedures like fillings and tooth extractions. Previously companies did not consider root canals to be a basic procedure. Now most of the companies do categorize root canals under basic procedures because of the frequency of cases.
• Major procedures:
Major treatments includes procedures like crowns, bridges, dentures, surgical extractions and dental implants. So these are the areas covered by a dental insurance. But what does it cost for each one and how feasible it is to purchase insurance for each coverage?
A dental insurance sets a yearly maximum that you can use for dental work. This amount renews itself after every year. However, any unused amount is not forwarded, which means that you can spend only the maximum or below it in a single year. On average, this amount is around $1,000 according to the majority if insurance companies.
A company will have a network of dentists that offer services for the clients of the insurance company. If you get treatment from any of these dentists, you will have to pay nothing from your own pocket.
However, when visiting a non-participating dentist, it is important that you refer to what is known as the UCR rates of the insurance company. UCR stands for Usual Customary and Reasonable. This is a list of procedures and related rates that an insurance company will pay. For example, the UCR rate for a filling may be $70. If the dentists charges you $80, you will have to pay the difference from your own resources.
Insurance companies will also have a waiting period. This is the time they will take to confirm your insurance claim. Major procedures may have long waiting periods. The waiting period for a crown may be 12 months. This means that you could have paid for the crown yourself using the premiums during the waiting period. Always keep such things in mind.
Also, most insurance companies will not pay for any pre-existing conditions. This means that if a person already had a missing tooth when he applied for insurance, the company will not pay for a dental implant or bridge for that tooth until a specified time limit has passed.
The downside of insurance is that almost no company pays for cosmetic dentistry. The reason is that an insurance company will run in a debit for many years before your premiums pay for the procedures. The best option in this case is to participate in a dental discount plan.