A: This is a very common question, asked by nearly every patient before every visit! If you have dental insurance this is a very important question, because not all policies are created equally! The typical insurance plan we see covers 100% of preventative and diagnostic care, 80% of basic care (fillings & extractions) & restorations, and 50% of major care (crowns, periodontal) and reconstruction. That said, your plan could be very different. Some plans have deductibles, ranging from $50.00-$200.00.
It is the patient's responsibility to understand their benefits. To find out exactly what your plan covers, ask your employer or benefits administrator to give you this information. It should also be available to you online. At Mary T. Dooley, DDS we perform a benefits check before every appointment, so we are always able to tell you what your copay will be. We are also able to ask for a preauthorization from your insurance company to give you a better idea of what your insurance may pay towards any larger dollar work! As an extra perk, we are also happy to give you a benefit report, just ask for a copy at your next scheduled appointment.
Finally, don't let the words "out of network" scare you. Contrary to what your insurance company may lead you to believe, you may have more coverage than you think if you go out of network. Some plans coverage is up to 100% regardless of provider participation for diagnostic and preventative care. (Diagnostic & preventative means your yearly visits with exam, x-rays and cleaning.) Remember, regular care is your best insurance! Most big problems are preventable with regular care!
Do you have a question you'd like us to answer? Submit your questions in the "reply" section here or email us at office@drdooleydental.com. We hope you've found this questions helpful. Be sure to check our website for a list of other frequently asked questions!
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