Dental Insurance Plan Limitations

Dental Insurance Buford GA

Do You Know Your
Dental Insurance Plan Limitations?

To begin, we would like to highlight a misconception: dental insurance plan is not designed to pay for all of your dental care. Your dental coverage is not based on what you need or what your dentist recommends.  It is based on how much your employer pays into the plan. Employers generally choose to cover some, but not all of employees’ dental costs.

Our fees are based upon a combination of our costs, our time, and our consistent dedication to providing our patients with the highest quality of dental care. Thus, there is often a discrepancy between the amount covered under your policy’s UCR schedule, and the actual cost of the procedure. The discrepancy is the patient’s responsibility.

Terms You Need To Know
It is the amount you must pay before your dental plan benefits kicks in. Dental plans renew annually, and you must meet your deductible once each year.
Annual Maximum
This is the maximum amount your dental plan will pay during the plan year. You are 100% responsible for any cost above the annual maximum. Annual maximum for most dental plans are in the $1,000 to $1,500 range. Unfortunately, it has not been adjusted for inflation in the last 50 years. Each family member usually has a separate annual maximum.
Dental procedures that are not covered by the plan.
Frequency Limitations
How many times a procedure is covered during a specific period. For example, one cleaning every 6 months, or X-Rays every 2 years.
What is Pre-existing Conditions
No coverage for dental problems that existed before you enrolled in the plan. For example, your plan will not cover replacing a tooth that was missing before the effective date of coverage.
Least Expensive Alternative Treatment (LEAT)
Also referred to as downgrades, it occurs when insurance companies elect to pay for the least expensive procedure if there is more than one acceptable option. In this situation, the patient can receive any treatment but if they elect for the more expensive (non-covered option) they will have an increase in out of pocket portion. Filings and crowns are often downgraded. Please note that the treatment options recommended by our practice is never based on what your insurance company will pay, rather it is based on what’s in your best interest.

As always, feel free to contact any member of our staff for clarification on services, billing and insurance

Dr. Nimisha Patel Profile Pic

Dr. Nimisha Patel

Dr. Patel graduated from the University of California School of Dentistry (UCSF) and went on to complete advanced studies and continuing education courses in reconstructive, cosmetic, and implant training at the Advanced Dental Implant Research and Education Center (AIC). As an enthusiastic dentist with comprehensive dental expertise, Dr. Patel is proud to combine modern techniques and high-tech equipment to provide personalized and comfortable care to her patients.

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