At Family Dental Health, our goal is to make your dental visits as pleasant as possible. Part of this effort includes taking the complication out of utilizing your insurance benefits. Dr. Case knows there can be confusing terms and stipulations in insurance plans that can be a barrier between you and the care you need. We aim to remove that barrier by filing paperwork for our Portland patients and providing the details necessary for you to make the best decisions possible for your oral and overall health.

Am I covered?

Similar to medical coverage, there are numerous types of dental plans, typically with a focus on prevention. What does this mean? It means Dr. Case wants to keep your mouth free of infection and pain, and your smile bright and beautiful. If you are insured, your dental plan can help us achieve this goal. How? Usually with 100% coverage of preventive services, such as professional cleanings (known as prophylaxis in the dental world), x-rays, and checkups.

If your employer offers dental coverage, you might wonder if it’s worth buying into. We know the costs can seem steep, but when you consider how important your oral health is to your overall health, and the fact that you want to keep all of the teeth you have, its significance becomes a bit easier to recognize.

What else is included?

When you wind up in need of more than a cleaning (it can happen to the best of us), most carriers will pay 80% of the cost for cavity fillings, tooth extractions, and/or root canals. If you’ve suffered a dental injury or an infection that’s caused the need for more extensive restorative services, such as crowns, bridges, surgical extractions, or dental implants, these may be covered up to 50%. When it comes to cosmetic treatments such as Invisalign®, teeth whitening, or veneers, we’re sorry to say that insurance rarely covers these expenses and you will have to pay out of pocket.

However, that doesn’t mean you can’t look into these options if you desire a confidence boost in the form of a brighter, more beautiful smile. Many dental offices accept payment from financing companies like Compassionate Finance™ and CareCredit®.

Common Insurance Terms

  1. Premiums – Your premium is the annual or monthly cost of your insurance. If you’re insured through your employer, this is often extracted from your pay. Your premium does not include copayments or deductibles.
  2. Copayments – Your copay is either a predetermined flat rate per visit or a percentage of the total appointment cost. This will vary plan by plan.
  3. Deductibles – This is probably the most confusing part of insurance coverage for most people. Insurers are used to answering the question: “Why do I have a deductible when I already pay a premium?” Although it seems superfluous, it’s to keep the monthly or annual costs lower, as well as the copay. When you’ve met your deductible, your insurance plan will kick in and cover the percentages as outlined in your plan.
  4. Plan Maximums – With the focus on prevention when it comes to oral health and dental insurance, the majority of dental coverage plans have maximums, and they tend to run low. If you’ve met your annual maximum, additional services will require out-of-pocket payment. This is another instance when financing plans can come in handy, but even more importantly: your diligent oral hygiene routine, a healthy diet, and healthy lifestyle.

What if I don’t use my benefits?

Unfortunately, there are no rollovers in dental insurance. If you’re paying a premium, it makes sense to take advantage of preventive care at 100% of the cost, or other services at a discount. Besides, Dr. Case loves seeing your smile and takes pride in making visits pleasant!

The more you see us, the more we’re able to note what is and isn’t normal for your teeth, gums, tongue, saliva production, jawbone… the list is longer than most suspect at first! If we do catch a problem, it’s easier on your health, schedule, and wallet to treat it at the earliest stage possible. It’s also hard to beat the feeling of a professional cleaning. Our hygienists are gentle but thorough when it comes to removing tough tartar, which forms rather quickly if plaque is left to harden.

How can Family Dental Health help?

If you have additional questions about your dental insurance, you may be able to find the answers you need on the carrier’s website, by calling them directly, or reaching out to us, your Portland dentist. We are happy to help you get the most from your benefits, and we can provide pre-treatment estimates so you can budget accordingly.

The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.