Dental insurance varies greatly from provider to provider and from plan to plan. Because of this, there are sometimes instances where a dentist might recommend a procedure that isn’t fully covered or even partially covered by your dental insurance. When this is the case, you have a few options. If the procedure is medically necessary, you should never avoid getting it done. One option is to see if there are other procedures that could be done that are covered or if a different provider might be the right choice. Another option is to discuss payment plans or dental financing with your dentist. In this article we will go over your various options for what to do if your dental procedure is not fully or partially covered by your insurance. If you have any specific questions about a procedure or payment, give us a call or contact our Chicago offices.
While it isn’t true across the board, many dental insurance provide full coverage for preventative care. This includes your two trips to the dentist each year and the various materials and procedures that will happen at these routine visits. Dental sealants, fluoride treatments, x-rays, professional cleanings, and the exam with the dentist will all be covered for the most part. But other procedures including restorative procedures for fillings, root canals, and missing teeth might not be covered, or partially covered. With partial coverage you might have a co-pay. This means that your insurance will cover either a percentage or up to a certain amount and you pay the remainder. For example, some insurances will provide 50% coverage for fillings, this means you pay half as a co-pay. Another element to consider are deductible. A deductible is a set amount of money you will have to pay before your dental coverage comes into play. While deductibles are uncommon for preventative care they might be common for restorative procedures.
If your insurance doesn’t cover a specific procedure, it might be because there is coverage for a different procedure that solves the same problem. For example, your dental insurance might not cover dental implants but will cover dental bridges. Or maybe your insurance will cover dentures but not All-On-4 dental implants. This is because some insurance programs provide coverage for more affordable procedures that help with the same problem. At this point you will need to make a decision that strikes a balance between what is best for you and what makes sense for your insurance. For example, if you lose an adult tooth at a young age, a dental implant might be the best option. They are durable and they last longterm, but they are often covered by insurance. By contrast, a dental bridge might not last as long, and might need to be replaced when you are older, but it might be fully or partially covered by your insurance.
Another thing to consider is different payment options. For example, CareCredit is a medical financing solution that allow patients to pay for their medical procedures over time instead of all at once. Like a credit card, CareCredit works by providing credit in the present so that you can pay off the balance over time. CareCredit is only used for medical procedures and you do need to use a dentist or provider that accepts CareCredit. Another thing to consider is that some dental practices might provide a payment plan option. At the end of the day, no dentist wants a patient ignoring a medically necessary treatment because of coverage issues. Dentists, like doctors, want to make sure that their patients are living healthy lives, and it is often better to treat dental issues earlier than later, dental issues tend to spread over time.
If you live in the Chicago area and are interested in learning more about your payment options, please give us a call. We can discuss the various insurance programs we accept, as well as financing, and other payment options for various dental procedures.