Understanding Your Benefits Prior to Treatment: Important for You and Your Dentist

Dental coverage is a great benefit that is proven to improve oral health by making dental care more affordable. However, it's not designed to cover every dental service.

What happens when your dentist performs a service that is not covered by your dental benefits program?

When you're not aware of what specific services are covered under your dental benefits program, it's easy to see how a misunderstanding can arise with your dentist. Often, patients believe a service is covered if their dentist provided it. Unfortunately, this is not always the case. That's why it's important to be aware of optional and noncovered services.

At Delta Dental, patient (subscriber) education is a top priority, and we're asking dentists to play a key role too. Since you have a lot at stake, you have an important role to play as well.

What You Can Do To Understand Your Benefits Prior to Treatment

Review your certificate of coverage and bring it with you to your dental appointment. It is to your benefit to review any and all information concerning your dental program. The more you understand your program, the more you'll know about what dental services are covered and understand what you may owe your dentist. Bring this information with you when you visit your dentist – that way, you'll both be in the know.

Understand optional services. Delta Dental offers an array of dental benefit plans to employers. The benefits you receive depend on the plan options your employer selects. Payment policies differ for each program and likewise, not all treatments are covered similarly. Depending on the treatment, Delta Dental will pay only the applicable percentage of the fee for the maximum plan allowance for that service.

For example: If a tooth can be restored with a silver filling, but you and your dentist select a tooth color filling, payment based on the applicable percentage of the maximum plan allowance for the silver filling will be made toward the fee of the tooth color filling.

Additionally, in-network or out-of-network dentist selection also determines coverage level.

Ask your dentist to predetermine services over $200. If your dentist recommends a certain procedure that will cost over $200, ask him or her to determine what the fee will be in advance of performing the procedure so you have a clear understanding of what you will owe. This way, you and your dentist know up front how much will be covered under the benefit program and how much you will be required to pay for the service.

Understanding your benefits prior to treatment is an important step in your overall treatment – make sure you and your dentist are as informed as possible.