At our dental office in Charlotte, NC, we understand how difficult it can be to understand how dental insurances work. Hopefully, this blog entry will help clear up some of the misunderstandings.
Types of Insurances
There are many types of insurances out there. Most are provided through either you, your spouse, or your parent’s employers.
- PPO: This is the most commonly offered plan. It allows you to go to most dentists and offers the most flexibility in choosing your dentist.
- HMO: This plan usually limits you to a very small number of providers. Your providers are generally assigned to you. It is the most restrictive plan you can join.
- DMO: It is blend of the two plans. There will be more options in terms of picking your providers, but it will not be anywhere near the number of providers that a PPO plan offers.
A vast majority of dentists in Charlotte, NC will be able to accept to your PPOs. Less will participate in DMOs and a very small amount, if any, will participate in an HMO network.
Out of network and In Network
Being in network and out of network means a dentist will need to follow certain rules to get reimbursed for dental work. Our office here participates with most plans. However, there are limitations with each plan. For example, some procedures may not be covered or downgraded and may make billing unpredictable.
With that being said, as long as you have a PPO insurance policy, even if you’re “out of network”, we will be able to see you. And we will still be able to maximize your insurance benefit.
More information about the plans we accept in our dental office can be found here.
Benefits of Insurance
Every plan is different. Most plans offer at least 2 preventative visits to the dental office each year. This includes a cleaning, check-up, and X-Rays as needed. Having patients visit our Charlotte based dental office regularly for their routine cleaning generally leads to healthier teeth and lower out of pocket expenses over the long term.
In addition to covering preventative cleanings and basic dental procedures, some insurance plans will also help cover the cost of Invisalign. In Charlotte, NC, the average cost of Invisalign will range from $4000-$7000. We have seen plans cover anywhere from 0$ up to 2000$. That could mean half off your out-of-pocket cost!
Limitations of Insurances
There are downsides to insurance. Insurances cost money and they are in the business of making money. Every insurance has an annual maximum. This determines the amount that insurances will cover up to for the whole year. For people with healthy and straight teeth that do not get many dental procedures done, the insurance will cover everything. However, if you have a lot of dental work that needs to be done, the maximum is reached pretty quickly. This leaves you paying for the rest of the expenses over the maximum.
In addition to maximums, there are deductibles, missing tooth clauses, downgrades, age limits, and etc. As a result, it is becoming harder and harder to utilize the benefits that you pay for.
No Insurance No Problem
With more and more limitations on what dental insurances can do and cover, the advent of savings plans is becoming exceedingly popular. In our Charlotte, NC based office, we offer an in-house plan that is priced out to just under the normal cost of 2 cleanings, exams, and x rays. In addition, we also offer discounts on the services offered in our office. With our plan, there are no maximums and deductibles. You and your employer will not have to worry about paying an insurance company for a plan that may or may not pay for your dental needs. The billing will be much more predictable.
Hopefully, this article helps clear up some questions. If there are any other questions or concerns, our Financial Coordinator, Alyssa Harkey will be happy to help you. She works with the insurance companies every day. She verifies benefits, sends out claims, follows up on claims, and follows through with any needed appeals.