Dental Insurance is a highly complex subject that creates confusion for many people. The complexities of dental insurance and the lack of sufficient information provided by some insurance companies make it almost impossible for some patients to properly understand their benefits. Even more confusing is understanding how to properly work with your dental insurance company to achieve the highest level of benefits to which you are entitled.
Most dental insurance plans are different than medical insurnace in that there is a limited amount of benefit available per year, typically $1000-2000 per year. In addition there are deductibles, and copays (dependent upon type of procedure).
A typical plan provides a level of coverage known as 100/80/50 coverage.
- Preventive care—the exams, cleanings, and X-rays you receive during an average dental checkup—are 100 percent covered. Dentists recommend cleanings twice annually.
- Basic procedures like fillings, extractions, and periodontal work are 70 to 80 percent covered.
- Major procedures like crowns, root canals, dentures, bridges, or implants are 50 percent covered (or less).
There are variations in individual plans. For example, a root canal could be considered either a basic or a major procedure.
USE IT OR LOSE IT!
The insurance puts your annual benefit ($1000-$2000) into your dental benefits wallet every year. If you don't utilize the benefit, you lose it.
HOW OUR OFFICE HELPS
Our office will do everything possible to help you understand and make the most of your dental insurance benefits. We realize that dental insurance is complex and that it is extremely difficult to understand how to make it work or even to work with certain dental insurance companies. That is why we provide full assistance to you.
Our office will complete and submit dental insurance forms to the company to achieve the maximum reimbursement to which you are entitled and will work diligently to make this happen as quickly as possible.
Please be aware that some dental insurance companies take longer than others to complete payment. If necessary, our office will contact the dental insurance company, or we may request your help in this matter.
INSURANCE PARTICIPATION
There are different types of dental insurances. DMO or HMO type plans restrict you to seeing one specific dentist. Our office does not participate in any HMO or DMO type plans.
PPO plans are a preferred network, and many of these plans also have out of network benefit. Some of our doctors participate with some PPOs, we will work with you to maximize your benefits even if we are not in network.
Medicare does not provide any dental benefits, unless you have purchased a supplemental dental benefit for your medicare coverage. Our office does participate with some Medicare advantage plans.
Our office does not participate with any state run Medicaid or Medicaid related insurance plans.
Dr. Jain - Delta Premiere, United Healthcare, Aetna, CIGNA
Dr. Kim - Delta, United Healthcare, Aetna, CIGNA,
Dr. Faldu - Delta Premiere, Aetna, CIGNA
Dr. Braidy - Delta Premiere, Aetna, CIGNA
Dr. Sohal - Delta, United Healthcare, Aetna, CIGNA, *MetLife, *Guardian, *Horizon BC/BS, *Principal
(* Dumont office only)
Need help understanding your dental insurance? Give us a call at (201) 733-4819. Our staff is always here to help.
NO INSURANCE? NO WORRIES!
East Madison Dental now offers Preventive TotalCare for our patients. This program offers three different plans that allow you and your family to get the preventive dental care you need, without the expensive price tag. To learn more about this program, head to www.emdental/totalcare.
