Moms and dads, holiday season is under way with the familiar scents and events as we pull out those gorgeous leafy decorations, pumpkins (pumpkin everything, really) costumes, and favorite movies, in addition to tissue boxes for sniffling noses and chapstick. Before you know it, Thanksgiving will arrive, and then it’s a frantic busy slide right into Christmas and New Year’s Eve. It’s a fun time of year full of family gatherings and events, yet it also means that your insurance benefits are coming close to a lapse.
Most insurance plans include coverage for dental services for all members of the family in question. You are paying those monthly premiums, however have you checked to see if you’re maximizing the dental insurance benefits in your plan? Some things to consider:
- Has each child in your family had dental X-rays taken this year?
- Has each child in your family had 2 dental cleanings this year?
- Has one of your children complained about dental pain but you’ve forgotten about it in the everyday bustle of life?
- What is my copay?
- What is my maximum coverage amount per person in the family?
- Does my coverage include basic preventative care?
- Are X-rays covered?
- If yes, under what circumstances and/or with what frequency?
- Are dental cleanings covered?
- If yes, how many per year?
- Are fluoride treatments covered?
- If yes, are their age restrictions for fluoride treatments?
- What is my coverage for basic restorative care?
- Is basic restorative care covered up to a certain amount or is a percentage of it covered?
- What is considered basic restorative care in my plan?
- Is in-office sedation covered in my plan?
Basic preventative care typically covers two dental cleanings per year, some plans include a fluoride treatment at the cleaning appointment under the coverage, while others do not. Other insurance plans only cover fluoride treatments for certain ages.
Annual X-rays may be covered by your insurance, while yet other plans only cover them when deemed necessary by the dentist. Such circumstances when X-rays would be necessary would be in preparation for restorative work.
Some plans may cover mouth guards for children under preventative care but not all. Which is unfortunate due to the fact that we know dental injuries are common and preventable with the use of mouth guards when engaging in any type of sport activity!
Basic restorative care typically includes fillings, dental emergencies such as chipped or knocked loose teeth, as well as crowns or root canals. It’s important to ask your insurance questions about basic restorative care, due to the fact that while fillings are almost always covered, they might have restrictions on said coverage. For example, most people prefer composite fillings on the grounds that the composite material blends in with the color of the tooth so as to not be obvious. Some dental plans may only cover amalgam fillings, which are structurally sound but have the disadvantage of being metal in appearance and therefore not very discreet.
Don’t be surprised if you learn that your plan will only fully cover some basic preventative care services. It’s pretty common for restorative care to be partially covered. Partial coverage can mean that they’ll cover up to a certain amount in a year period for each member of your family (or in some cases a certain amount per family) while with other insurance providers, partial coverage means the insurance company will cover a percentage of restorative care services.
Furthermore, some insurances cover partial until a threshold is reached. Upon reaching that threshold, you may be entitled to full coverage again. Accordingly, if this is your circumstance, it’s important to find out how close to that threshold you are.
When you are checking the details of your dental coverage with your insurance provider, it’s a good idea to ask for details about sedation. Our offices provide three different sedation options:
- Oral Sedation – prescription sedatives for the night prior or the day of a procedure or visit, we may suggest and also implement if your child suffers dental anxiety or has developmental delays that may cause difficulties for dental procedures.
- Nitrous Oxide – also referred to as “laughing gas” is most often utilized in conjunction with a local numbing agent for restorative dental procedures.
- Intravenous Sedation – unlike general anesthesia utilized in hospitals by surgeons, our intravenous sedation technique does not inhibit the protective reflexes, which mainly means our patients under intravenous sedation can breathe on their own.
Any time we consider in-office sedation, we first review the options, the benefits, including the circumstances with the parents. If there is a concern for cost and/or insurance coverage, we will work with you and together we’ll find a solution.
We work with most insurance companies, if you don’t find your provider on this list, give us a call to double check that your provider isn’t a new addition.
- Assurant/Sun Life Financial
- Anthem BCBS
- Regence BCBS
- BCBS Federal
- Blue Cross of Illinois (Blue Care)
- Blue Cross of Michigan (Blue Dental)
- Dental Select
- Dentist Direct/Direct Care Administrators
- Delta Dental
- GEHA – Connection Dental Network
- Humana – Connection Dental Network
- Life Map
- Lincoln Financial Group/Lincoln Dental Connect
- Traditional Medicaid
- Medicaid Premier Access
- Premier Access PPO
- Premier Access Chip
- Principle – EMI Network
- Standard Life Insurance/Reliance Standard
- Select Health
- Utah Sheet Metal/JAS/Southwest Service Administrators
- United Concordia PPO
- United Concordia Tricare/Active Duty
- United Healthcare – GEHA/Connection Dental Network
Don’t wait for your dental benefits to expire! Some dental services require impressions that must be sent to a lab for production which means a time lag of at least a week. Schedule an appointment with your pediatric dentist before the holiday season speeds up.
We’re hosting a Disneyland Giveaway for one family this November, enter to win and that lucky family can be yours! We’ve established 12 different methods for you to enter the sweepstakes, moreover there’s no limit to your total number of entries. On November 15th, we’ll draw the name of one lucky family. Wouldn’t it be wonderful if it was your name? For more information on how to enter, click here.