How Dental Insurance work

How Dental Insurance Works

In order for your dental insurance to stay active, your employer charges you a premium every month.  Normally, they’ll take it right out of your paycheck, so you never have to worry about it. All you need to do is present your insurance card whenever you visit the dentist.

But dental insurance is a bit different from medical insurance, so it’s important that you understand exactly what you’re paying for.  We’re going to review a few features found in common policies. Keep in mind that your individual plan could be different, so it’s important to check with your person of contact.  This could be someone in Human Resources at your job or a representative at the dental insurance company itself.


Yearly Maximum

Most dental insurance policies come with a yearly maximum that they’ll pay toward your dental work. A common amount is anywhere from $1,000 to $2,000 per year.  Once they’ve paid their limit, they won’t cover anything else for the rest of that calendar year.

Another thing to keep in mind about the yearly maximum is that in most cases, any unused benefits don’t roll over.  So if you don’t use it, you lose it. And since you’re paying the premium every month you’ll want to take advantage of your benefits by at least coming in for checkups and cleanings.


How Does the Dental Insurance Company Determine Payment?

With most procedures, there’s still an out of pocket expense that’s involved. For example, if you need to have a filling done the insurance policy will likely pay 50% – 80% of the fee – leaving you to cover the rest. Other procedures that are paid at this rate may services such as crowns, prosthetic devices, tooth extractions, and root canals.


Submitting the Insurance Claim

As a courtesy, most dental providers will submit insurance claims on your behalf.  They’ll send in a narrative explaining why the procedure was needed, along with evidence like photographs or x-rays of the tooth, which show why it was diagnosed the way it was. The company will review the documentation provided by the dentist and their professionals will determine whether or not the procedure was deemed necessary.

Once the insurance approves or denies the claim they’ll send a check along with documentation to the dentist.  You’ll also get a copy of the paperwork (Explanation of Benefits, a.k.a. EOB), so you can see what was decided.  Remember, any portion of the fee that the insurance doesn’t pay, is the responsibility of you as the patient.


Know Before You Buy

Before you agree to pay for an insurance policy you should really become familiar with its benefits.  The truth of the matter is that being covered isn’t always necessary. Especially if you have a healthy mouth and hardly ever need dental work done, you may find that it’s better to just pay out of pocket for your dental checkups and cleanings.

At Raleigh Dental Arts our top dentist in Raleigh, NC offers flexible payment options.  Give us a call today and we can help you decide which route is better for you.


Tarun Agarwal

Dr. Tarun Agarwal, DDS is considered one of the top dentists in the country. He is a recognized speaker, author, and dental leader. He has been featured on CBS, NBC, ABC, FOX, and News 14 Carolina. Dr. Agarwal has been awarded '40 under 40' Business Leaders by the Triangle Business Journal. He is regularly invited to teach other dentists around the world and recently built a training center within the practice dedicated to sharing his expertise. Most importantly he is a loving husband and dedicated father of three wonderful children. His biggest accolade was being voted 'Best Dad in the World' by 2 of his 3 kids.