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Common Questions

Does My dental insurance work the same way as my medical insurance?

Dental insurance is not like health insurance. Dental insurance is based on a contract between the employer (or plan sponsor), the insurance company and you, who bears full responsibility for settlement of your financial obligation to our office. Most contracts have limits and/or various degrees of co-payment.


What is my maximum coverage?

The maximum cumulative coverage for a "benefit year" for most dental plans is between $1000 and $1500. Dental insurance is never a "pay-all"; it is only an aid. This is often a surprise to the patient because regardless of how much dental treatment they may need the dental insurance company's responsibility is usually capped at a relatively low amount.

What is a deductible?

A deductible is the set amount you must pay before your insurance coverage begins.  Most dental insurance has deductibles between $50 and $100. Please check with your insurance carrier to determine your deductible amount.

What is the percentage that my insurance will pay for your services?

We make every effort to provide you with a reasonable estimate of what your plan is likely to pay.  Unfortunately, because of such things as maximums, deductibles, non-covered procedures, etc., calculating the exact coverage is impossible.  Dental plans may cover as little as 0% to 80 % of dental services.

How much does a root canal cose?

Each endodontic case is different and fees vary accordingly.  Once an examination and consultation are completed, we will be able to tell you the fee and an estimate of how much your dental insurance will cover.  Because dental insurance covers only part of the root canal fee, you are responsible for paying the remaining balance.

Why was my benefit different than what I expected?

Many plans tell their participants that they will be covered "up to 80% or up to 100%", but they do not clearly specify plan fee schedule allowances, annual maximums or limitations (such as exams per year allowed, or 1 panoramic X-ray in 5  years). It is more realistic to expect dental insurance to cover 35% to 65% of our services.  It is rare that 100% of costs will be covered.  The amount a plan pays is determined by how much the employer has paid for the plan.  In addition, your dental benefit may vary for a number of reasons, such as:

-How many benefits remain for the current year for you in your plan

-The percentage your insurance plan will pay for any endodontic fee

-The treatment needed was not a covered benefit

- You have not met your deductible

-You have not reached the end of your plan's waiting period and are currently ineligible for coverage.


Why can't you tell me exactly how much I will owe you for treatment?

At the time of service, your portion of the payment responsibility is only an estimate. Our staff will perform a benefit check to assess your benefits under your plan as well as complete the dental portion of your claim form and submit it on your behalf.  The amount of the precise financial responsibility is determined by your dental insurance company after the claim has been filed. A final statement will be issued to you.

What happens if I have used all of my benefits for the current insurance year?

Once your annual maximum has been met, the insurance company will not provide additional benefits for any dental service until the renewal period. Each policy is different. Please read your policy so that you are aware of your benefits and limitations.

Your claim will be filed immediately, and benefits are expected to be paid withing 30 days. The filing of an insurance claim does not relieve you of timely payment on your account.  If the claim is not cleared by your insurance carrier withing 45 days, the unpaid portion will become  the sole responsibility of the insured and or the patient.  You are responsible for any amounts your insurance company chooses not to pay, for whatever reason.  Should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly.  We will gladly provide all pertinent information to you at no charge.

Why isn't the recommended treatment a covered benefit?

We diagnose and provide treatment based on our professional judgment and not on the cost of that care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs.  Your plan may not include this particular treatment or procedure, although we deemed the treatment necessary and in the patient's best interest.

Will the treatment be painful?

We will take every measure to ensure that your procedure is in no way uncomfortable or painful. If treatment is needed, we will inject a small amount of anesthesia to gently numb a concentrated area of your mouth. For most patients, the feeling of numbness usually subsides after 2-3 hours.

Will I need to return to your office for follow-ups after the procedure is finished?

Yes, for most root canal treatments, we recommend that patients return to the office 1 year after the procedure was finished. Our office will send a reminder notice to you when you are due for a recall appointment.