Lake District Family Dentistry

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Use it or lose it Dental Insurance

September 24, 2015

This month we want to remind you to take advantage of your remaining insurance benefits before it’s too late!

DENTAL INSURANCE BENEFITS: USE IT OR LOSE IT!!!

We are quickly approaching that time of the year again… We call it, “Use it or Lose it!” Sadly, every year there are patients who lose out on hundreds of dollars through their dental insurance providers simply because time has slipped away. We hope to educate you so that you can better understand how dental insurance benefits work and make sure that you take advantage of your coverage!

Understanding Dental Benefit Categories

Most dental plans offer 3 categories of coverage. If orthodontics is a covered benefit, it is considered a fourth class and typically has a separate lifetime maximum payable amount. Each category of coverage provides specific types of treatment and typically covers those treatments at a certain percentage. Reimbursement levels vary from plan to plan.  Knowing what your specific plan allows is your responsibility so be sure to read your benefits information carefully.

Here are the typical levels in benefit plans:

Diagnostic & Preventive (Class I)

  • Procedures are diagnostic and preventive which includes procedures such as dental exams, cleanings, and X-rays.
  • They are typically covered at the highest percentage (for example, 90 – 100% of the allowable dental charge).
  • Patients are offered this higher coverage as a financial incentive because such care can prevent more extensive dental disease.

Basic (Class II)

  • Basic procedures such as fillings, extractions, and periodontal treatment which are covered at a slightly lower percentage (for example, 70 – 80%).

Major (Class III)

  • Major services, such as crowns and dentures which are typically reimbursed at about 50%.
  • Many insurances will have a waiting period before these services are covered.

Orthodontics (Class IV)

  • Early/Interceptive, Limited or Comprehensive Orthodontic services are often reimbursed at 50% up to the lifetime maximum.

Limitations and Exclusions

  • Dental plans are designed to help with a portion of your dental expenses, not pay for all of your dental needs.  Plans may contain limitations and exclusions to limit the type or number of procedures covered, the number of visits allowed, or may impose age limits.

Having dental insurance is beneficial to use a “coupon” for your needs but should never dictate if or how you opt take care of your oral health! If you pay for the coverage, you should use it in the given time frame specified in your plan.  Don’t let it go to waste!

Contact us today if you have questions about your remaining dental insurance benefits or to schedule an appointment! The team of Lake District Family Dentistry would love to see your smile!

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