These are some common definitions to help you better understand the way your insurance plan works. Each company may have variations to the way they pay benefits, so please call if you have any questions or concerns about your specific plan - we are always happy to consult with you on how to best manage your dental plan benefits!
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In Network versus Out of Network
This phrase is used to denote whether a dentist has signed a contract with your particular plan to write off a portion of the regular fees. This allows a reduced fee for patients and is only applicable for patients with insurance plans that we have signed a contract with. Companies we are currently participating preferred providers with are: AlwaysCare, Blue Cross Blue Shield of Louisiana, Cigna Radius, Delta Dental, United Concordia, and Metlife.
A specified amount that each patient must pay before benefits are paid. This is not usually applied to regular check-ups. Generally, a deductible is $50 per patient, per plan, up to $150 per family.
Insurance Allowable Amount
Your plan pays a percentage of fees based off of a fee schedule determined by your insurance company. This fee schedule is rarely the same as general dentists' fee schedule, and may differ by as little as a few dollars or more depending on your insurance plan. Our fee schedule does not change per patient. Your insurance company does not release their fee schedule to us for us to be perfectly accurate, so our estimations may occasionally be a few dollars off.
Maximum Allowed Amount
The amount of benefit you can receive towards treatment based on your benefit year. Some plans' benefits turn over based on the month you signed up for your insurance plan, and some turn over based on the calendar year. The maximum allowed benefits payable range among patients from $1,000 per year to $1,500 per year.
Based on clinical diagnosis, our team estimates your out of pocket portion based on information received from your insurance company. While we try to be as accurate as possible, amounts can fluctuate. We occasionally file a Pre-Treatment Estimate to your insurance company. This allows us to obtain more accurate out-of-pocket portions for you, but your insurance plan does not guarantee payment regardless of their estimate.
Basic and Major Services
Insurance companies classify services into basic categories that they will pay a percentage of. Most companies will pay 100% of their allowed fee of Preventive services. Your plan may vary from these generalizations, and we are able to estimate more accurately based on your plan information.
- Basic services include fillings, periodontal treatment, oral surgery, and endodontics. Most plans pay 80% of their allowed fee for these services.
- Major services include crowns, bridges, and removable prosthesis (dentures, partials). Most plans pay 50% of their allowed fee for these services.
- Some plans requiring you to fulfill a "waiting period" before they will reimburse for certain categories.
- Your plan may have restrictions for payment, and we are happy to consult with you to find the most cost-effective way for you to manage your benefits.