Brecksville Dental Care

Dental Insurance

What Are Dental Insurance Coverage Types?

According to most dental insurance companies, dental procedures are broken down into three categories:

1. Preventative

Most insurance companies consider routine cleanings and examinations as preventative dental care, however, X-rays, sealants and fluoride can be deemed as preventative or basic, depending upon the specific insurance carrier.

2. Basic or Restorative

Basic or restorative dental treatment usually consists of fillings and simple extractions. Root canals can be considered basic or major. However, the majority of dental plans list root canals as basic.

3. Major

Crowns, bridges, dentures, partials, surgical extractions and dental implants are dental procedures that most dental insurance companies consider as a major procedure.

Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans don't cover major procedures and others have waiting periods for certain procedures. If you know that you will need major dental work that is not covered by a given plan, you should probably look elsewhere to find one that suits all of your needs.

What is the Maximum?

The yearly maximum is the most money that the dental insurance plan will pay within one full year. The yearly maximum will automatically renew every year. If you have unused benefits, these will not roll over. Most dental insurance companies allow an average yearly maximum of $1,000.

What is UCR (Usual Customary and Reasonable)?
  Almost all dental insurance companies use what is called a Usual, Customary and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.

Why doesn't my insurance cover Cosmetic dentistry?  Cosmetic dentistry is any type of procedure done for vanity purposes only. Teeth whitening is very popular. While the effects are gorgeous, keep in mind that 99.9 percent of dental insurance companies won’t pay for cosmetic dentistry.

Do I need Dental Insurance?  Before deciding to purchase dental insurance, talk with your dentist regarding the extent of your treatment plan. This way you can decide if you would be better off with or without dental insurance. A very important factor to remember regarding any dental insurance plan is that dental insurance is not at all similar to medical insurance. The majority of dental insurance plans are designed with the purpose of only covering the basic dental care around $1,000 to $1,500 (about the same amount that they covered 30 years ago) per year and is not intended to provide comprehensive coverage like that of medical insurance.

To help finance your dental care, many dental offices are now offering interest-free payment plans because they understand that dental insurance only pays a small portion.

Who should file my Insurance Claim? And follow up on my claim? 
It is YOU the insurance has to answer to, since you are the covered party. (And who pays the premiums, either yourself or through an employer). The dental office only files insurance claims as a courtesy. Too many times the insurance company will tell you that a claim was never received, when in actuality it is on somebody's desk or in a garbage can. Regardless of that, it is still your responsibility to make sure your services were paid for.


The responsibility falls on the insured to follow up on claims for work they had performed. Even if the office failed or neglected to file a timely claim - balance is still your responsibility.

We file insurance as a courtesy to our patients not because we are mandated or required in any way by the insurance company.

BRECKSVILLEDENTALCARE.COM
440-526-3388

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