Facts About Dental Insurance

Cosmetic Dentist serving San Francisco, Berkeley, Piedmont, & Oakland, California

Dental insurance is different from other insurance.  It is an expense account with an annual limit.  Plans vary but here is how a typical dental insurance plan works:

1. Any patient can see a private practice dentist out of network.  In network dentists have agreed to accept cut-rate fees for their professional services.
2. There is a typical annual maximum of $1,000 to $1,500 depending on the plan.  Patients are free to have treatment above and beyond their annual maximum by simply paying out of pocket for the balance.
3. There is usually a $50 deductible, meaning that you pay the first $50 of dental fees every year before your insurance pays anything.  Cleanings are often exempt from the $50 deductible. 
4. Your plan’s benefits are based on a fee schedule agreed to between the insurance company and the purchaser of the plan.  These fee schedules consist of fees that are almost always a lot lower than the dentist’s fees. Insurance companies call these fees “UCR” (“usual, customary and reasonable”) but in reality UCR fees are simply reimbursement amounts negotiated between the insurance company and the purchaser of the plan.
5. Cleanings are usually covered at 100% of UCR, fillings are usually covered at 80% of UCR, and crowns are usually covered at 50% of UCR.  Insurance companies will not pay more than the plan’s percentage of their UCR allowance for any service. Services such as Cosmetic Dentistry, TMJ treatment and Sedation are typically not covered.  A few plans have limited benefits for Implants and Invisalign orthodontics.
6. Dental insurance is a nice preventive maintenance program, which is useful for 2 cleanings and perhaps a crown or a filling in any given year.  For any extensive dental work, patients with or without dental insurance will face significant out of pocket expenses.  Our office will be happy to assist you in arranging low monthly payments to make high quality care affordable. 

To learn more about dental insurance or cosmetic dentistry costs, please contact our Piedmont cosmetic dentist today!