Understanding insurance maximums and frequencies can be very confusing and frustrating to a dental patient, but hopefully by reading this blog, we can help those patients tackle that frustration.
Most insurance plans start over every calendar year (January 1 to December 31). This means the maximum dollar amount patients are eligible for on their plan also starts over. The denomination of this maximum is either pre-set by the employer with the insurance company, or by whichever option the patient chose with the insurance company (if it is a personal plan). Plan maximums can range anywhere from $500 to $5000, however it is ultimately the patient’s responsibility to know this maximum, and to keep track of how much they have accumulated towards it. At Braeside Dental Centre, we are more than happy to send an estimate to insurance companies before any treatment is done so our patients can be aware of what could be covered. Most insurance companies will only send the response to the member, whether it is the patient or their spouse or parent. Therefore, we will kindly remind the patient to forward that to us once they have received it, ensuring that we become aware of what could be covered as well. While we understand that insurance can be a large factor in making decisions regarding your dental work, we also want to ensure that every patient receives the care that they need to maintain healthy smiles. Sometimes, the care necessary to conserve great oral health is not covered under the patient’s insurance plan. We are all unique, and so are our dental needs. In these instances, we will most definitely prioritize your health, but we will have also established a relationship with our patient that allows for us to work together to maximize what we can out of their plan.
Another aspect that patients need to remember when it comes to the annual maximum under their plan, is if it is a combined maximum. Some insurance companies may provide two separate maximums for basic treatment (exams, hygiene, x-rays, fillings, etc.) and major treatment (dentures, crowns, bridges) or combine the two. At Braeside Dental Centre, we encourage our patients to become familiar with the details of their plan so we have a better understanding of what is expected by patients regarding their appointments.
Patients may have been asked from their dental providers: What are the frequencies and amount of scaling units on your plan? This simply means that we are asking how frequent patients are covered to come in for their regular exams with the dentist and hygiene. When patients hear scaling, they are most likely not inclined to know what that is. Scaling is done by the hygienist, who uses a scaler to remove the plaque from patients’ teeth. Scaling units are determined by time. One scaling unit is approximately 8 to 15 minutes, and two units would be approximately 15 to 30 minutes. Some insurance plans have a maximum amount of scaling units included per year, though that may fall short of what is necessary to a patient’s health. However, as I mentioned before, Braeside Dental Centre wants to make sure your dental needs are being met above all else.
I hope that by reading this blog post, our valued Braeside Dental patients will be more secured in their understanding of their insurance benefits. I, as well as Jody and Faye, are always happy to assist our patients with any questions they may have regarding their insurance.