All recommended treatment during your dental visit is elective, unless you are in pain. In addition, there are numerous treatment options for each dental condition. These will vary in cost, treatment time and durability. For example, a missing tooth could be replaced by a partial denture (removable plate), a bridge (cemented) or a dental implant. The dentist will explain your treatment choices, the limitations and advantages of each and together decide on the best treatment for you. You and your dentist will prioritize those procedures which are necessary from those which are cosmetic and/or elective. As a thorough treatment plan can be costly, treatment can be phased over time, addressing those procedures which need urgent attention first.
Before you seek any treatment, make sure you understand the costs involved and when payment is due. Make sure that the dentist accepts your dental insurance first before arriving for your appointment. Do not automatically assume that your dental insurance will cover everything. Understand that even with insurance a good portion of the costs may be your responsibility. Insurance Companies are in business to make money, not to give you the finest marvels of modern dentistry but the least expensive way to treat a dental condition.
Most insurance plans have restrictions which limit your eligible coverage. These would be in the form of deductibles, co-payments, waiting periods, annual or lifetime maximums and exclusions. You need to ask your insurance co. what these exclusions are. For example, most will cover the silver fillings but not the white composite restorations. The amount of dental coverage you have is negotiated between your employer and the insurance company. Any questions regarding limitations in coverage should be directed to your employer and not your dentist. While benefits should be taken into account, it should not be the deciding factor in your choice of treatment. You should base your treatment around your dental needs and not your dental plan.
The dentist submits "your" insurance claim at no cost and as a courtesy to you. They will usually provide you with an estimate that will show expected insurance reimbursement and your share of the costs for every procedure. This share is due at the time of treatment unless prior arrangements have been made. Should no insurance payment be made within 60 days of a submitted claim, the fee will become the sole responsibility of the patient. Some dental offices require payment in full from you at the time of services and will forward the insurance payment to you once received. The insurance information obtained for you by the dental office is a guideline only and is no guarantee of payment. You are ultimately responsible for all payments. The only way to obtain written coverage for your proposed treatment is to preauthorize it with the insurance carrier. This predetermination of benefits is still not a guarantee of payment. This usually takes 6 weeks, which may not be in your best interest to delay urgent dental treatment.
If you are uncertain whether to proceed with the recommended treatment get a second opinion (find a dentist) or you can call the local dental society in your area for a referral (find dental societies). If you feel that you have been improperly treated or dissatisfied with the level of care you received, you can contact your state or local dental organization, which usually offers peer review to mediate disputes between patients and dentists. These services are available free of charge to patients.
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