What Determines My Out of Pocket Expenses for Dental Care?

What Determines My Out of Pocket Expenses for Dental Care?

Insurance can give you a headache. Sometimes it gives us one, too! Fortunately for you, the financial coordinators at Raleigh Dental Arts are learned in the ins and outs of dental insurance policies and procedures. But even then, every plan can vary from one to another. When we outline a treatment plan, it’s only a good estimate based on what information your insurance company is willing to share with us.


Your insurance plan is most likely purchased by your employer, and you pay premiums for the insurance out of your paycheck.  The out of pocket cost for treatment depends on the type of plan purchased by your employer.

Here are some of the major factors at play:


“Is Your Dentist In-Network?

This is the first question to ask when figuring out your out of pocket dental costs.  All dentists have the option of working with different insurance providers, in other words, being network providers for those companies. This is good news for you because it decreases your cost. In many cases (PPO plans) you can still go to an out of network dentist, but you’ll pay a little bit extra.


“So What’s My Deductible?

The deductible is the amount you have to pay before the full benefits of your dental insurance kick in.  For instance, if your dental insurance covers 80% of your crowns or 50% of your fillings, that’s after you pay your deductible. If you have a deductible of $500, you must pay that amount first before your insurance benefits kick in. Be sure to ask about your annual maximum as well!

“What is My Annual Dental Maximum?”


Most dental insurance plans have an annual maximum of around $1,500. This is the total dollar amount that they will pay for your treatment (such as fillings or crowns) after you’ve met your deductible. Once you’ve exceeded that amount, you are responsible for the remaining balance. The reason for this, is because most dental insurance plans are prevention driven. They want you to see your dentist regularly so that you don’t need a lot of expensive restorative work later on. The more frequently Dr. Agarwal can see you, the more likely we can intervene before problems become irreversible.


“Why Doesn’t My Insurance Plan Cover Certain Dental Procedures?”

Your insurance plan is typically purchased by your employer. If you are unsatisfied with the level of coverage provided, you’ll need to contact your Human Resources department. The benefits coordinator at Raleigh Dental Arts will do everything possible to help you get the most out of your benefits. Feel free to let us know if you have any questions!