If you are uninsured, we want to help. Blue Sky Family Dentistry offers an office membership plan. For $250 you get two exams, a comprehensive set of x-rays, two cleanings, fluoride varnish, and an oral cancer screening every year. We believe in making dentistry affordable and that keeping up with preventive services like cleanings is critical for your oral health.
As your South Austin family dentist in Circle C, Dr. Corpron wants you to understand your dental insurance benefits and he insists on transparency. We accept all Dental PPO plans, and the following is a list of all the dental insurances with whom we are in-network:
Dental Health Alliance
Dental Network of America
Blue Cross Blue Shield of Texas
Get To Know Your Dental Insurance
Dental insurance can be confusing. At Blue Sky Family Dentistry we believe in transparency when it comes to your insurance. We want you to understand your dental benefits so you can get the most out of your dental insurance. Surprises regarding bills or insurance claims is one of the main reasons patients lose trust in the dentist, and this can all be avoided with a little conversation.
To help you navigate your dental insurance, Dr. Corpron has put together a list of terms that you should know. He goes into more detail in the blog, but the snippets below will give you a good start.
Dental Insurance PPO
This stands for a dental Preferred Provider Organization. This can be considered an open access plan. If you have this kind of plan you can see any dentist you like, but in-network providers will be much cheaper since they have a contract with the insurance company to only charge certain fees for specific services.
Dental Insurance HMO
This stands for dental Health Management Organization. This is a closed network plan. If you have this kind of plan your insurance will only help you if you see a dentist who is contracted within that network. If you see any dentist outside of this network you will be responsible in full.
This is an annual fee you have to pay before your insurance will pay out. The fee is set by the insurance company and is triggered by certain types of dental care like fillings or non-preventive services.
Almost all dental insurances have annual caps to how much they will pay out. Many fall into the $1000-2000 range but some go up to $5000. A plan with a higher maximum will likely cost you more on an annual basis but will go further for you if you have a lot of dental care needs. There are also lifetime maximums for services like orthodontic care if you need braces or Invisalign.
This is cost-sharing by the dental insurance companies. They will often expect you to pay anywhere between 20%-50% for each procedure. This varies wildly from plan to plan.
If you have a Dental HMO plan then you often have a fixed amount that you have to pay for every visit. This is different from coinsurance since it’s not based on a percentage. It is a flat rate per visit based on what treatment you are receiving. If you have a dental insurance HMO, then you should receive a list of covered treatments and their copayment amounts.
These are important if you have a lot of dental needs. As the name implies, it is an estimate to give you a ballpark figure for how much your dental care will cost and how much the dental insurance will contribute. This is important so you can plan ahead.
Exclusions and limitations
Dental insurance is riddled with these. There will simply be a lot of services they don’t want to pay towards or limits to how many times they will pay for certain procedures. Cleanings are a good example. Any dental insurance plan worth anything will pay for at least two cleanings a year, but they may not pay for a third or fourth cleaning even if you need that to treat periodontal disease. That would be a limitation. An example of an exclusion would be orthodontics or Invisalign. Many dental insurance plans will not pay for orthodontics because they don’t think it is necessary even though it is often the best way to help you achieve optimal dental health. The same often applies to dental implants. Whether or not a treatment is covered by your dental insurance plan has nothing to do with its importance or relevance to your overall dental health. It just means your dental insurance doesn’t want to pay for it. If that’s the case, many dental offices, including our own, have financing options in place to help you navigate your way to optimal care.
Okay, that’s a lot of info. If you want to learn more give our office a call!