SOUTH WEYMOUTH, MA
When it comes to dental insurance, most people want it and are glad to have it. When it’s time to actually use the insurance on something other than a routine cleaning–like an unexpected filling, a chipped tooth there or worse, a root canal or crown—it’s a little too late. Doing a little research into your insurance benefit before you really need is a wise move as the out-of-pocket costs resulting from not having a good plan or understanding what your particular plan covers can really add up.
“Most dental plans cover basic examinations and cleanings, but some plans may not cover things you might assume to be routine,” said Dr. Richard Wolfert, DMD, who conducts his dental practice at 1121 Main Street in South Weymouth. “That’s why the expertise of the staff and communication with the insurance company is so vital. I’ve found that most misunderstandings with patients are the result of the patient’s belief that their insurance will or should pay for more than it will.”
Most dental insurance companies classify dental procedures in three categories:
- Preventative – This typically includes routine cleanings and examinations as preventative dental care, however, X-rays, sealants and fluoride can be deemed as preventative or basic, depending upon the specific insurance carrier.
- Basic or Restorative – This usually consists of fillings and simple extractions. Root canals can be considered basic or major depending on the plan (the majority of dental plans list root canals as basic).
- Major – Usually includes crowns, bridges, dentures, partials, surgical extractions and dental implants. But not always.
While preventative and basic procedures are fairly straightforward, some dental plans do have some requirements, like “waiting periods” for major work. For example, if you need a crown and the policy has a 12-month or longer waiting period, you WILL NOT receive reimbursement for that procedure until you’ve been enrolled in the plan for at least one year. That means, if you decide to move ahead on getting that procedure done before the waiting period has been met, you will be responsible for the entire cost.
Some additional fine print to be on the lookout for: “missing tooth” clauses or a “replacement” clause. Many plans include at least one of these clauses, but most have both.
A missing tooth clause allows the insurance company not to pay for the replacement of a tooth that was missing before the policy was in effect. A replacement clause is similar. The insurance company won’t reimburse you for such procedures as crowns, dentures, partials or bridges until a specified time limit has passed. That time period could be five to 10 years.
“Another critical thing to know about your plan is the maximum amount of annual coverage you’re allowed. Typically it’s around $1500 but many plans have a deductible that needs to be met before the benefit is allowed to be paid out,” said Wolfert. “Sometimes, in order to take advantage of your dental benefit, you need to play the insurance ‘game’. If you know you need a certain procedure that’s going to be particularly expensive you can plan to do a part of the procedure at the end of one year, taking advantage of that maximum, and then finish the procedure the next year when you have more benefit at your disposal.”
Added Wolfert, “This does not work with all procedures because you may not be able to split the work into two or three phases, but some may.”
Dr. Wolfert’s practice, Smiles by the Toothboss, is located at 1121 Main Street in South Weymouth, Massachusetts, and accepts most insurance plans. They also accept payment from most PPO and indemnity plans, including Blue Cross/Blue Shield and Delta Dental.
For more information on Smiles by the Toothboss, visit Dr. Wolfert’s website at www.toothboss.com or call 781-335-0604 to schedule a consultation.
About Smiles by the Toothboss
Smiles by the Toothboss offers: comprehensive examinations (written treatment and treatment plan provided); cosmetics; crowns, bridges and tooth-colored restorations; partial and full dentures; periodontics (early cases treated); oral surgery; restoration of conventional and small diameter implants; and emergency services (24-hour emergency phone number available).
Smiles by the Toothboss accepts most insurance plans. They also accept payment from most PPO and indemnity plans, including Blue Cross/Blue Shield and Delta Dental. They also accept all major credit cards and have arranged payment plans through CareCredit.
To schedule an initial consultation, please call 781-335-0604. For more information, visit www.toothboss.com.