Day in and day out we, at Kneib Dentistry, deal with dental insurance and explain to patients how their specific plan benefits them. We figured that a lot of patients are not very aware of how their dental insurance plays its role.
Insurance plans come in many "shapes and sizes" and they can change at any time. Speaking in general terms, the typical insurance plan will only pay out a maximum of $1000 towards an individual's dental care throughout a given year. For some, this may be more than enough and for others, this may only benefit minimally compared to their specific needs. Most insurance plans will require a yearly deductible of typically $25 or $50 to be paid by the patient before the insurance will pay towards any treatment.
When utilizing a "participating" dentist, it simply means that the dentist is contracted to charge a specific fee for services that the insurance sets, as opposed to the dentist's fee. The percentage the insurance covers is the percentage of the contracted fee and the patient is responsible to pay the remaining amount of the contracted fee. So, the patient essentially receives not only the benefit of insurance paying towards treatment, but also the "discounted" services.
In conclusion, although a patient may have used their yearly maximum allowance (typically $1000), they can still choose to receive services at a discounted rate using a participating dentist.
If you have dental insurance, it is always important to at least utilize it by having your routine examination and cleaning, which insurance typically covers at 100%. So why not take advantage of it to assure your dental health!
Call us at 814-838-6354 and we would gladly help you in better understanding your dental insurance.