Understanding Your Benefits
What You Can Do To Understand Your Benefits Prior to Treatment
- Review your certificate of coverage or dental benefits booklet 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 will 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 we allow for that service. For example: If a tooth can be restored with a silver filling, but you and your dentist selects 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. You’ll likely enjoy more out-of-pocket savings if you visit a network dentist.
- 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.
What happens when your dentist performs a service that is not covered by your dental benefits program?
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.
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 of Illinois, patient 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.
Important for You and Your Dentist
Most patients value a strong relationship with their doctors and dentists. As with most relationships, a strong relationship is built on trust and good communication. Your relationship with your dentist is no different.
The Dentist-Patient Relationship
You may have a long-standing relationship with your dentist or you may be selecting a new dentist. Whatever the case may be, all patients have individual preferences and different expectations from their relationship with their dentists. Generally, quality, comfort and cost are key factors that affect your relationship with your dentist. Dentists are responsible for providing quality oral health care that is necessary to treat a specific patient in accordance with professional standards. Patients must find a dentist who they and their family think responds well to their oral health needs.
Making an Appointment
Scheduling an appointment with your dentist may be a difficult task at times. Like many other doctors, dentists have patients scheduled for regular check-ups and exams months ahead of time. Your dentist may not have an opening for a month or more for non-emergency appointments. Of course, emergencies should be accommodated for more quickly.
Questions for Your Dentist
You play a key role in your treatment. You should be informed as possible. Here’s a few questions that may help:
- What are my specific oral health needs?
- What treatment options are available for my needs?
- What options would yield the best outcomes for me?
- What can be treated now and what can be treated later?
Share Your Oral Health Risks with Your Dentist
Delta Dental of Illinois is pleased to offer access to myDentalScore – an online risk assessment tool that will give you an easy to understand oral health score report.
Oral health problems like periodontal disease and tooth decay are more common than you may think – and left untreated they can lead to more serious problems, such as tooth loss. Take just a few minutes to answer some simple questions and you will receive an oral health score report that estimates your risk of tooth decay, gum disease and oral cancer. Please note that none of your personal health information (PHI) is ever revealed and the survey can be taken anonymously.
After completing your assessment, print out your report to bring to your next dental appointment. Share your results with your dentist and, if needed, he or she can help you create a treatment plan focused on improving your oral health and upping your score.
If you know your specific risk factors for tooth decay, gum disease and oral cancer, you can take simple preventive action to avoid these problems. Get a handle on your oral health by taking advantage of this practical health management tool.
It's a smart way to get wise about your oral health.
Explanation of Benefits (EOB)
After a trip to the dentist's office, you'll likely receive an EOB from your dental benefits carrier explaining the procedures performed and what is covered by your dental plan.