Oshkosh Smiles – Dental Insurance Questions

Do you have questions about dental insurance? You are not alone.

Knowing the benefits of your dental insurance can save time and improve your overall health. By seeing your dentist regularly, you can catch dental problems before they get too serious and require more extensive and expensive procedures.

To help you on your journey toward a healthier smile, we have created a video of the most commonly asked dental insurance questions.

“My Dental Insurance is out of network. Can I still be seen at your office?”

YES! You will still have insurance coverage at our office.  Sometimes the coverage is exactly the same, or a service may be covered, but at a different percentage. For example, an in-network plan may have coverage for a service at 100%, whereas an out-of-network provider may have coverage at 80 or 90%.   A lot of our patients choose to stay with us, even though their plan is “Out-of-Network”, because they know the quality of care they are getting is worth the difference!

“What is the difference between Dental and Medical Insurance?”

The biggest difference between Dental and Medical insurance is your deductible. A dental insurance deductible is typically only a $50 or $100 fee that is charged once a benefit year for any services other than preventative. Another difference between dental insurance and medical insurance is the dental maximum. The dental maximum is an allowance that is given to you each benefit year to use towards your dental services and is a much smaller allowance than a medical maximum.  Although there are differences between dental and health insurance, sometimes we are able to utilize both plans by billing them together when certain services are performed. Some of the services that could be billed under both your medical and dental are biopsies, certain extractions, and TMJ splints. If x-rays and exams are needed due to a medical accident, we also may be able to utilize both your medical and dental benefits.

“Do I need to bring my insurance card with me to my appointments?”

It is very helpful for our office to have a copy of the patient’s insurance card. We are able to help patients best maximize and utilize their benefits each year. We are able to find out their detailed benefits faster, and also able to find out any special benefits the insured might not be aware of. For example, adults being able to have fluoride treatments covered two times per year, and more frequent cleaning appointments covered.

“How often should I come in for dental cleanings?”

A lot of patients don’t know how often to come in for their routine dental visits, most think it is only every six months. However, some plans have extra benefits that allow you to come in every 3 months! If a patient is pregnant, has diabetes, periodontal disease or, or has a suppressed immune system (which can be caused by medical conditions or medications you are taking) they could receive extra benefits that are “hidden” in their plan. If a patient’s plan has this benefit, we are able to enroll them to receive extra cleanings and sometimes fluoride treatments.

We encourage you to contact us with any dental insurance questions you may have.