Why Doesn’t My Insurance Pay for That?

Nothing is more frustrating than when your insurance company denies a claim.

Whether you’ve just had a procedure done or are planning to have one, insurance confusion can add a whole new layer of stress to your life.

Fortunately, we’ve had plenty of experience with this matter here at Marconi Dental Group and we’re ready to answer your questions!

Are You A “Preferred Provider?”

We’re in-network with a wide variety of insurance companies. But each company has the right to decide who they want to sign a contract with. The insurer may not cover much if you are visiting an office they don’t have an agreement with.

Whether or not an office is a preferred provider says nothing about the quality of the care. Don’t be tricked into thinking that an out-of-network dental practice is a bad one! Just be aware that you’d have to foot more of the cost.

Am I Covered For This Procedure?

What you are covered for largely depends on what your employer and insurer agree upon.

Perhaps your dental plan covers you for basic and preventative procedures such as fillings and x-rays. But when a freak accident knocks out a tooth you could suddenly realize that you don’t have coverage for a dental implant. Such unexpected events can throw a spotlight on weak areas in your dental insurance policy.

It’s important to note, as well, that insurance companies are free to set the rates they like. They will determine what they feel is the usual cost for a procedure and only cover up to that amount. What’s left is your responsibility. The sad part here is that your insurer may not change that rate to reflect the rising cost of dental care or economic variation in geographic location.

Do I Need To Pay Out-of-Pocket For An Extra Procedure?

Most insurance companies set a limit for dental procedures.

For example:

  • 2 Cleanings per year
  • 1 Set of x-rays per year
  • 2 Exams per year
  • 1 Dental crown per tooth every 5 years

These limitations don’t take into account the fact that someone may need to have a new crown sooner than five years. Nor the fact that a patient with gum health complications needs more frequent cleaning appointments. An emergency dental visit may require an unanticipated set of x-rays.

All such situations could stick you with disappointing out-of-pocket costs.

How Can I Get Better Dental Coverage?

First of all, you’ll want to have a discussion with your employer about your dental benefits. If you feel that your plan isn’t meeting the needs of you and your family, you need to talk with the person in charge of selecting your plan.

Here at Marconi, we recommend treatment you need, not just the procedures your insurance covers. We’ll help you work around the obstacles and make your treatment as affordable as possible. One of the best ways is to schedule a checkup every six months, so that we can diagnose conditions earlier. When you do need treatment, ask us about our financing options and in-house dental plan.

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