Important for the end of the year:
Your benefits expire at the end of the calendar year.
Your benefits do not roll over.
If you have dental benefits left for the year, give our office a call and we can help you save money, get healthy and maximize your benefits.
We work with your insurance!
At Smile More Dentistry and Washington Dental Associates we accept almost all insurance providers.
- We are experts at maximizing your benefits and minimizing your out-of-pocket costs, while providing the highest level of care. We will help you navigate through your dental insurance and help you maximize your benefits
- Our main goal is to help you take good care of your teeth. We will file your claim for you and let you know before treatment what your portion is, if there is any. We will always prioritize your dental health before anything else.
- We do NOT take State insurance such as Medicaid, NJ Direct, Amerigroup, United Health Care Community, and Fidelis. We do, however, have several days of FREE dentistry for those that have these insurances.Click here for more information.
Make Your Dental Health the Top Priority
Although you may be tempted to make decisions about your dental care based on what insurance will pay, remember that your health is the most important thing.
Dental insurance is one part of your healthy mouth plan. If you find out what your dental plan covers and plan accordingly, it can help you have a healthy mouth. We will work with you and your insurance to take the best possible care of your smile so they will last a lifetime!
Don’t have insurance? Not a problem! We offer our “Smiles Savings Club” for patients without insurance.
Understanding your Dental Insurance
Insurance benefits can be confusing, so when you come into our office, we will explain all your benefits to you. We will file all the claims and let you know what is not covered before doing any treatment.
Having dental insurance or a dental benefit plan can make it easier to get the dental care you need. But most dental benefit plans do not cover all dental procedures.
Your dental coverage is not based on what you need or what we would recommend. It is based on how much your employer pays into the plan.
When deciding on treatment, dental benefits should not be the only thing you consider. Your treatment should be determined by you and what we diagnose you need. Our office will always put your needs first. Not what the dental insurance covers.
How Dental Plans Work
Almost all dental plans are a contract between your employer and an insurance company. Your employer and the insurer agree on the amount your plan pays and what procedures are covered.
Often, you may have a dental care need that is not covered by your plan. We will work with you and your budget and help you prioritize work needed.
Cost-Control Measures Used by Dental Benefit Plans
Key terms used to describe the features of a dental plan may include the following:
UCR (Usual, Customary, and Reasonable) Charges
UCR charges are the maximum allowable amounts that will be covered by the plan. Although these terms make it sound like a UCR charge is the standard rate for dental care, it is not.
The terms “usual,” “customary,” and “reasonable” are misleading for several reasons:
- Insurance companies can set whatever amount they want for UCR charges. They may not match current actual fees charged by dentists in a given area.
- A company’s UCR amounts may stay the same for many years. They do not have to keep up with inflation or the costs of dental care.
- Insurance companies are not required to say how they set their UCR rates. Each company has its own formula.
This is the largest dollar amount a dental plan will pay during the year. Your employer decides the maximum levels of payment in its contract with the insurance company. You are expected to pay copayments and any costs above the annual maximum.
A dental plan may not cover conditions that existed before you enrolled in the plan. For example, benefits will not be paid for replacing a tooth that was missing before the effective date of coverage. Even though your plan may not cover certain conditions, you may still need treatment to keep your mouth healthy.
Coordination of Benefits (COB) or Nonduplication of Benefits
These terms apply to patients covered by more than one dental plan. The benefit payments from all insurers should not add up to more than the total charges. Even though you may have two or more dental benefit plans, there is no guarantee that all of the plans will pay for your services. Sometimes, none of the plans will pay for the services you need. Each insurance company handles COB in its own way. Please check your plans for details.
Plan Frequency Limitations
A dental plan may limit the number of times it will pay for a certain treatment. But some patients may need a treatment more often to maintain good oral health. For example, a plan might pay for teeth cleaning only twice a year even though the patient needs a cleaning four times a year. Make treatment decisions based on what’s best for your health, not just what is covered by your plan.
Not Dentally Necessary
Many dental plans state that only procedures that are medically or dentally necessary will be covered. If the claim is denied, it does not mean that the services were not necessary. Treatment decisions should be made by you and your dentist.
If your plan rejects a claim because a service was “not dentally necessary,” you can appeal.