It’s open enrollment season!

We understand — Navigating insurance is always a tough task. This time of year, many of our patients spend countless hours in their HR departments trying to figure out which plan works best for their situation.  We want to educate you about which things to consider on potential plans before making a decision.

As you shop for dental insurance, here are some things to consider:

  1. Every plan offers different levels of coverage. This includes, how much the lifetime maximum is, the percentage the plan is covered at, how the insurance company pays, etc.
  2. Confirm that you are “free to choose” your provider. This is crucial since our office is only contracted with Delta Dental. By confirming that you are able to choose a provider, you’re ensuring that you remain in control of where your treatment is completed, whether it’s within our office or not.
  3. Ask how the policy coordinates benefits. The answer should either be “standard” or “non-duplication”. This is of utmost importance especially if you are double covered. If you are not familiar with these terms, let me explain. When a patient has double coverage, primary and secondary insurance is established by an insurance standard known as “the birthday rule”. The birthday rule considers both subscribers birthdays and establishes primary based on the month and day of each subscriber. Once that’s done, the insurance then, has an additional provision that basically says how they’ll coordinate the benefits with another policy. This provision applies mainly to the secondary plan. If the secondary plan has a standard coordination of benefit, then you’re in luck! We’ll be able to bill and collect on both. However, if the secondary plan has a “non-duplication” coordination of benefits, then we can only bill and collect on the primary policy and the secondary policy is forfeited. Long story short; make sure the secondary plan has a standard coordination of benefits.
  4. Just because it’s Open Enrollment, doesn’t mean you have to change insurance plans. In fact, if you’re currently in active orthodontic treatment, it’s best to continue with the same coverage. Why? Because you probably haven’t exhausted the lifetime max from the current plan. You see, when treatment started, our office took into consideration the lifetime maximum that we were going to be receiving from your insurance company. Your insurance company makes small, monthly or quarterly payments throughout the course of your active treatment leaving your account with a continual running insurance balance until that lifetime maximum is set.
  5. If a change in insurance plans is inevitable while in active orthodontic treatment, you’ll want to confirm the new policy covers work in progress. Work in progress means you’re in active orthodontic treatment from the effective date of the new plan. While this isn’t ideal, it’s still doable with a little extra effort. The new plan will prorate the remaining treatment based on the new coverage level. Any remaining balance (or credit) at the end of treatment, will be settled with our office.

Click this link for a copy of our insurance flyer.

Related Posts

Leave a comment

This site’s strategy, design, photo & video were created by the marginally-above-average folks @ Clear Partnering Group.
We are Open! Here’s what to Expect at Your Next Appointment. Find Out More