How does dental insurance work?
Understanding dental insurance can be challenging as there are many different types of plans out there. Your dental insurance plan is a contract between you and your insurance company. The benefits outlined in your plan were chosen by your employer.
In-Network Doctor: Doctor signs a contract with an insurance company and is limited to only charge a patient the fees, deductible, and copay created and set by that particular insurance company.
Out-Of-Network Doctor: Doctor has no contract with an insurance company, although, they typically still can send an insurance claim on a patients behalf. The doctor will then collect the difference between what the insurance company pays and the fees set by that particular doctor's office.
Dental insurance helps to cover some of the costs of dental treatment and each individual contract specifies what types of procedures are considered covered benefits. A typical PPO insurance benefit may look similar to this:
Preventative care: 80-100% (Exams, X-rays, Cleanings)
Basic care: 80% (Fillings, Root Canals, gum scaling, Extractions)
Major care: 50% (Crowns, Bridges, Implants, Dentures)
Please Note - the types of dental procedures that a particular insurance plan will cover are unique and diverse. Even if a procedure is medically necessary, it may be excluded as a covered benefit from your particular plan.
Kansas Dental Center will work to verify your dental insurance before your appointment, help explain the details of your specific plan, and provide you with our best estimate of what your particular plan will cover.
Downgrades and Alternative Treatment
Downgrade Composite Fillings To Amalgam Fillings - An insurance company will sometimes only pay based off of the Least Expensive Alternative Treatment (LEAT); that means even though a composite "tooth colored" filling was used to restore a tooth, the insurance company will downgrade that procedure to an amalgam "silver filling" and only pay based on the silver filling fee.
Tooth colored fillings are made of more expensive materials and require more time and technique to place than silver fillings. The patient is responsible for the difference in cost between the composite "tooth colored" filling and the amalgam "silver filling", if their particular plan downgrades composite to amalgam.