You will find that many of you will pay for dental insurance every month but do not have a clue of exactly their dental cover work. This will make patients end up overpaying for treatment or delay treatment that they you may need urgently and in other cases avoid having covered treatment performed because of lack of knowledge concerning what their dental insurance covers.
Understand Your Plan
Delta dental premier insurance is supposed to assist patients to cover their costs while maintaining a good dental health. One should be fully aware of the provisions and limitations of their individual dental plan. It can boring going through the plan document but you should do it before using the benefits. The patient is responsible to pay for the services rendered and not the insurance company or the dentist office. You will be far less likely to end up with claim denials and unexpected dental bills if you clearly understand how your plan works.
Most Preferred Provider Organizations (PPO) have provisions like fee reduction when they have services rendered by a participating network provider. In most cases, the participating provider has an itemized fee schedule that provides for fee reductions of the total price. This is done even before any insurance plan payments are made. An example of such a situation is that dental implants may not be a treatment that is payable by your insurance plan but the network dentist may have agreed to a reduction in the regular fee. Most services that are covered for delta dental ppo plus premier dentists have a reduced fee from 10 – 35% off the regular fee. You may find that some Dental Maintenance Organizations do not pay claims for any services performed by a non-network provider.
Read Your EOB
An EOB is an Explanation of Benefits. It is a statement that is provided to both the patient and the dentist every time a claim is paid. Ensure that you read it and fully understand the contents. Compare it to your itemized receipt for services provided by a particular dentist. You have to make sure that your plan has paid the claim correctly. In some cases you might find that there are charges that were unpaid or denied, find out why.
Ask for a “Pre-Determination” of Benefits
In most cases, dental work is not an emergency. You will find that there is time between when the treatment is recommended and when it is actually performed. During this period, ask your dental network provider to send a predetermination of benefits to your insurance.
Know the Limits
Delta dental PPO providers have an annual maximum. This is the total amount your policy can pay in a single year. If a dental claim is filed by a dentist and is not paid because you have reached the limit, you will have to foot the bill on your own. Most insurance companies do have a limit on the number of office visits on dental cleaning and x rays covered annually.