|
INSURANCE FAQ
Q: ARE COSMETIC PROCEDURES COVERED BY MY INSURANCE?
A: No. Insurance does not cover cosmetic procedures. However, in some cases, cosmetic issues can arrise from functional issues, which are more likely to be covered.
Q: WHAT ARE THE DIFFERENT TYPES OF DENTAL INSURANCE COVERAGE?
A: With most dental insurance companies, dental procedures are brokendown into three categories: Preventative, Basic/Restorative and Major.
Preventative usually includes routine cleanings, exams, x-rays, sealants and fluoride. However, some insurance companies deem x-rays, sealants and flouride as basic/restorative instead of preventative depending upon the indivual policy
Basic/Restorative is dental treatment usually consisting of fillings, simple tooth extractions and root canals. Although, some dental plans consider root canals under the major category
Major generally includes crowns, bridges, dentures, partials, surgical tooth extractions and dental implants
Since all dental insurance companies and all dental insurance policies are different, it is important to clarify with your dental insurance company the specifics of your individual policy.
Q: WHAT IS “USUAL, CUSTOMARY AND REASONABLE?
A: Almost all dental insurance companies use what is called “usual, customary and reasonable” (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what that dental insurance company wishes to cover. For example, a dentist may charge you $88 for a dental cleaning, but your insurance company will only allow $70, because that is their UCR for that procedure. In this case you may be required to pay the difference.
|
