How to Get the Most From Your Dental Insurance

With regular visits to the dentist for cleanings down to emergencies, we want you make sure you're getting the most from your dental plan.

Using Your Dental Insurance

While it's common knowledge that a solid routine of of brushing and flossing daily at home is essential to keep your smile bright and healthy, it's also essential to schedule regular dental visits to maintain your oral health.

The good news is you've got a great dental plan that makes it both simple and affordable to get the care you need.

The following are some tips and suggestions for before, during and after your dentist visits to help you get the most benefit  from your dental insurance.

BEFORE YOUR VISIT
Here are the three things you should do BEFORE your dentist appointment:

  1. Review your dental benefits: check out what's covered —and what's not— in your dental plan by logging into your MySmile® account, or reading your benefits booklet. Eliminate any surprises during your upcoming visit to the dentist office by knowing your facts before you go!

  2. Choose an “in-network” dentist: in-network dentists are also known as “participating dentists”, because these dentists participate in a specific dental network and they offer their services at discounted rates for members of that specific dental plan. In-network dentists also file all of your claims paperwork for you. Use our Find a Dentist tool to find an in-network dentist.

    You do have the option to see a non-participating (a.k.a out-of-network) dentist, but be aware that you do not receive dental services at the same discounted rates. You will then be responsible for paying the dentist the costs above the dental insurance plan's allowed fee for that service. Some out-of-network dentists may also not submit insurance forms on your behalf unless you request it, otherwise it will be your responsibility to insure the benefits are paid.

    When you have the choice, it will always be the most cost-effective option to go with an in-network dentist for the most affordable, and hassle-free experience.

  3. Know your out-of-pocket dental costs: when you go to the dentist lacking the information, it can cause unnecessary stress, and sometimes even cause you to postpone the treatment needed due to the anticipated expenses you may incur. When you know in advance what you will have to pay for treatment, it gives you the ability to plan your expenses, and be prepared.

    A quick and simple way to get this information is by using the Cost Estimator. It's a great online tool that provides instant, personalized out-of-pocket cost estimates based on your benefits and the dentist you selected. It’s also a great way to look at your dental costs for a range of different treatments. In some cases, the dentist may offer you treatment options, and this can be a great way to assess your possible out-of-pocket costs for each option.

 

AT YOUR VISIT
Here's a short list of just three things you want to do during your visit to the dentist:

  1. Share your dental plan information with the office: Present your insurance card, and if you have more than one insurance plan, be sure you bring both cards along and show them both and clarify the coverage with the office staff. Since they will be submitting the bills to the insurance company, they need all the details required to insure the proper billing is done from the start.

  2. Share your medical history: Many dentist offices will have a background questionnaire for new patients to complete, which helps them understand the full picture and any precautions they need to take when treating you. If your dentist office has not already asked for your general medical history, it's necessary you share such details in advance of your treatment, which will help them give you the best care and avoid any complications. In addition to advising the dentist of any medications you take, you should also advise of any medical conditions such as:
    • Cancer
    • Diabetes
    • Heart disease
    • Pregnancy
    • Allergies

  3. Request a pre-treatment estimate: Ask your dentist to submit a pre-treatment estimate of benefits before starting any extensive, and potentially expensive treatment. Assuming the the recommendations are not of an urgent nature and you are scheduling a follow up appointment anyway, have the predetermination submitted first. Once submitted, you’ll receive a Confirmation of Treatment and costs. The confirmation will verify the specific treatment plan prescribe, as well as what your benefits pay, along with an expected out-of-pocket estimate.

 

AFTER YOUR VISIT
Log in to your MySmile account, click on “My dental activity” and check your Explanation of Benefits (EOB). Your EOB details how much of your benefits were applied towards your treatment, and any remaining payments that may be your responsibility.

**Note: you will receive a copy of the EOB in the mail if you don't have a MySmile account.

When reviewing your EOB on line or when it arrives in the mail, here are the three things you want to confirm:

  1. Verify treatment: This may seem obvious, but you want to confirm that the treatment you were billed for is the same treatment you received. There are many codes for procedures and treatments that are used in the insurance world and the use of the wrong code by the dentist's billing department can cause discrepancy on your billing, and in some cases, lack of payment or reduced payment made by the for the claim.

    **TIP: Save ALL your EOBs, even if everything checks out and there's no questions or discrepancies. The EOB's are needed if you itemize deductions on your tax return, and as proof of qualified expenses if you use an HSA or FSA account for your medical expenses.

  2. Review your maximums and deductibles: there are often times where the dentist will explain there is a need for some additional treatment. When you know your maximums and deductibles, and where you stand for the benefit period, it will be helpful when scheduling future treatments to try to avoid exceeding your benefits for that year.

  3. Confirm other dental coverage (when applicable): If you have another dental insurance plan in additional to Delta Dental, and that one is your primary coverage, you want to insure the EOB's have the correct plan information and the billing was done as it should. If there is any question, contact your dentist's