How it works?

Just like medical and vision, dental insurance is usually provided by your employer who pays a monthly premium associated with that coverage. Your plan will have guidelines on what doctors you can see, and what benefits are provided. Dental insurance works differently than medical insurance with the main difference being that the dental insurance provider has a yearly maximum that they will reimburse, where as the medical insurance provider covers reimbursement after the individual reaches their own out of pocket maximum.

How can I check my dental benefits coverage?

You can always contact your insurance company to get an exact breakdown of what they cover. You can also check online for in-network doctors that will accept your plan. Don’t feel like being on hold with your insurance company? Give your subscriber ID and carrier name to a member of the Wilson Family Dentistry insurance team and we’ll check your coverage for you.

What does my dental insurance cover?

Most dental PPO plans provide coverage based on a range of services which they divide into three categories: Preventative, Basic, and Major. Exams, x-rays, regular cleanings, are all examples of preventative services that are typically covered at 100%. Basic services are typically covered at 80% and at 50% for Major. This breakdown is plan specific and can vary widely among the thousands of different benefit plans that are out there.

You are responsible for what is not covered by your insurance plan. Keep in mind – once your yearly maximum is met, your insurance will not reimburse for any service and you will be responsible for the full fee. To be best prepared for your dental appointment we recommend consulting your personal benefits to understand your coverage.

What does in-network vs out-of-network actually mean?

If we are in-network with your insurance carrier it simply means that we have a direct contract with negotiated prices. You don’t need to see a provider that is in-network but you will likely save money if you do. That being said, if we are out-of-network with your insurance carrier you will still be able to take advantage of certain dental benefits. After paying the base price, you will be able to submit to your insurance for “out-of-network” benefits and be reimbursed directly by them.

How many cleanings does my insurance cover annually?

Typically, two exams and two cleanings in a calendar year.

Did you know – exams and cleanings are preventative services that are often covered at 100% for both in-network and out-of-network benefits.

Are implants covered by my insurance?

Sometimes. There are exceptions and rules that are sometimes difficult to navigate prior to care. In these instances, we recommend submitting a pretreatment estimate to your insurance to get a more accurate explanation of benefits. (We will do this for you)

Is Invisalign covered by my insurance?

Many plans include some sort of orthodontic benefit. Some plans have an age-limitation, meaning that they will only provide that benefit up to a certain age (usually 19 years old). If you are shopping for an insurance plan and interested in orthodontic treatment make sure to look for an age limitation. The Wilson Family Dentistry insurance team can help you navigate the rules that are specific to your plan.