Many dental insurance plans list treatments as “covered services,” but that does not always mean the insurance company pays the full cost. Factors such as coverage percentages, annual maximums, and plan limitations can affect how much is actually reimbursed. Understanding how plans like Physicians Mutual dental insurance work can help patients better estimate their dental expenses.
One of the most common questions we hear from patients at Clove Dental involves the word covered.
Patients often assume that if a dental procedure is listed as a covered service, their insurance company will pay the full cost. But in many cases, that is not exactly how dental insurance works.
The reality is that being covered only means that the procedure would receive benefits- it does not necessarily mean that the insurer would pay the full cost.
In the case of those who have some plans such as Physicians Mutual Dental Insurance, knowing that distinction can be made to eliminate confusion.
In dental insurance, a covered service is a treatment that qualifies for reimbursement under your policy.
However, coverage normally implies that the insurer will reimburse a part of it and not the entire amount.
An example of the plan may include:
The remaining portion is the patient’s responsibility.
Cost sharing is used in the majority of the dental plans. That is, you and your insurer make up the bill.
The coverage can typically be divided into three buckets:
1. Prevention (exam, cleaning)
2. Simple surgeries (fillings, simple extractions)
3. Fabricated structures (crowns, braces, dentures)
Physicians Mutual Dental Insurance is no exception and has the same model with minor differences in percentages depending on the policy.
Even when a service is covered, several factors may affect how much insurance actually pays.
One common factor is the coverage percentage. If a treatment is covered at 50%, the patient is responsible for the remaining half.
Second, the annual benefit max will determine the amount of money that will be wasted by the insurer in a benefit year. After you reach that limit, you are on your own in the rest of the procedure.
Before we treat you at Clove Dental we walk you through such details to know what will probably be covered.
Plans such as physicians mutual dental insurance often provide coverage for a range of preventive, basic, and major dental procedures.
However, like most insurance policies, they usually include-
Because of these factors, patients may still have some out-of-pocket costs even when a treatment is considered covered.
Patients are sometimes surprised when they receive a bill after using their dental insurance.
Some common situations where this can happen include-
After a dental insurance claim is processed, the insurance provider typically sends a document called an Explanation of Benefits, or EOB.
The EOB outlines-
At Clove Dental, we often help patients review their EOB statements so they can better understand how their insurance payments were calculated.
While dental insurance can help reduce costs, it’s still important to estimate potential out-of-pocket expenses.
One step that is good to make is to confirm your coverage prior to treatment. Contact your office to confirm benefits and provide an estimate of a break down in case you have Physicians mutual Dental Insurance.
By doing so you are aware of the extent that you are responsible and can prepare.
A dental plan has a couple of tricks so that you can maximize on it. We often suggest-
By taking these steps you can make the best out of what your insurer provides.
Dental insurance can help reduce the cost of dental care, but understanding how coverage works is important.
Just because a treatment is listed as a covered service doesn’t always mean the insurance company will pay the entire cost.
At Clove Dental, we help patients review their insurance plans, including physicians mutual dental insurance, so they understand their benefits and feel confident about their treatment decisions.
Why do patients still pay for treatments that are covered?
People do so due to the fact that the majority of policies do not cover the full cost, but a part of the cost.
What does “covered service” mean in dental insurance?
Covered service a type of treatment that is reimbursable under your plan but you will still probably need to pay some.
Does Physicians Mutual dental insurance pay for all covered treatments?
No, it covers a piece of the slice of the amount of coverage according to the percentages and limits of the plan.
How can patients reduce out-of-pocket dental expenses?
Patients can review their insurance coverage, schedule preventive care visits regularly, and discuss treatment options with their dental provider before beginning procedures.