Maryville, Alcoa and Knoxville TN
Do you have access to dental insurance? If so, and you have tried to use your dental coverage when receiving care from your dentist in Knoxville, you probably know that dental insurance and medical insurance can function in very different ways. A dental coverage plan may be restricted by waiting periods, limitations on how frequently you can go to the dentist, caps on maximum benefits paid, and even outright exclusion of certain services. Understanding the specifics of a dental insurance plan can be a challenge, so Cedar Street Family Dentistry put together this primer so that you can make the most of your dental insurance benefits in Knoxville.
Like most benefit plans, dental insurance plans are composed to cover just a portion of the total cost of care
From the perspective of the employer, dental insurance classifies as a “money benefit,” which is provided by the employer to help employees and their families pay for dental care. The specifics of each dental coverage plan are negotiated with the insurance company your employer chooses. Plans vary from employer to employer, and even from year to year. Moreover, insurance companies may not do their due diligence to notify policyholders about changes in their coverage.
There are two key components of each dental insurance plan that you, the consumer, should be able to understand and identify:
First, familiarize yourself with the terms “usual and customary” and “allowable amount.” These phrases are used to describe the dollar amount that your employer has negotiated with your insurance company. These amounts usually are significantly lower than what dentists actually charge. Insurance companies then pay a negotiated percentage of the cost of procedures, based on these amounts. For example, if your insurance benefit pays 50% of the cost of a dental crown, but your dentist charges $800 for a crown, that does not mean that your plan will pay $400. Instead, it pays half of a pre-negotiated rate, which could be much lower than what your dentist charges.
Second, know the specifics of your deductible, and what it applies to. This amount also is negotiated between your insurance company and employer and is paid out of pocket by you before the insurance benefits kick in and begin to cover the cost of certain procedures. Deductible requirements will vary from company to company and even from plan to plan.
Dental insurance plans may not cover all the desired treatments
Each plan is different, but in many cases, dental insurance plans sometimes will not cover cosmetic treatments. Dental insurance does usually pay on restorative procedures and oral surgery, although only certain types of restorations may be covered and not others. We recommend checking with your dental insurance so that you have the latest information on the specifics of your plan.
Using your dental insurance in Knoxville
At Cedar Street Dentistry, we work with many types of dental insurance, including PPOs. We do not belong to any managed care network such as an HMO. Our administrative and accounting staff can help prepare all the forms you need to use your dental benefits. However, remember that we cannot guarantee any specific amount that your insurance company will pay towards a dental procedure. In any instance in which insurance does not cover the entire cost of treatment, you are responsible for paying any remaining financial obligation. However, Cedar Street Family Dentistry accepts an assortment of payment options. Our office also works with CareCredit, which offers third-party financing to cover medical and dental costs.
According to the NADP’s latest statistics, about 74 million people in the United States do not have dental insurance—roughly double the number of Americans without medical insurance. If you are fortunate enough to have dental insurance, be sure to use it! Any unused dental benefits will expire at the end of the year. Whether you have insurance or you do not, Cedar Street Family Dentistry believes that finances never should be the deciding factor when determining your level of care. To learn more about our payment policies or to see if we work with your dental insurance provider, just give us a call at (865) 233-7640.
Cedar Street Family Dentistry welcomes patients from the areas of Alcoa, Knoxville, and Maryville, Tennessee.