Question: I need to find a family dental plan where we can all go to the dentist whenever we need to and pay the dental office bills after the dental insurance company pays their part before making us pay our share of the cost.

In the past, we had plans to pay the dentist upfront for the total cost of our dental services and wait for the insurance company to refund us. In this day and age, who can afford to do that? I know we can not. 

Those types of dental insurance plans keep us from going to the dentist, and at that point, I do not see paying $120 a month for a dental insurance plan we do not even use because we can not pay upfront for dental services. What options are left for us that would be more affordable?

Reply: Welcome! I hope you are doing well today. I want to discuss dental insurance plans and how claims are processed. I can understand why the claims process can be upsetting, particularly regarding how claims are paid. Let me assure you that you are not alone. Many people have questions about dental insurance plans and how they work.

Based on what you have told me, you have either a dental PPO or an Indemnity dental insurance plan. If you like the plan benefits and coverages overall and it is just about how claims are paid, consider talking to your dentist. With dental PPO and Indemnity plans, the payment process and how the dentist gets paid is really up to the dental office. It does not typically come from your insurance company.

The dentist can choose to submit the claim and get paid by the insurance company before billing out any remaining balances to their patient. In the past, many dental offices processed claims that way. However, sadly, many patients would fail to pay their part, and then the dentist’s office would have to chase them down for payment. This is why many dental offices have started billing their patients in full and making them file claims to the insurance company to get paid back (refunded) the part due them.

Some dental offices charge you what they think your part of the cost would be based on your policy coverages, then bill or credit you depending on the outcome. However, few dentists still do this, as it can still be an issue of fully getting paid for services already rendered.

Based on what we have discussed, it is not an issue with the insurance plan per se but more of knowing how your dentist is willing to file claims and how they expect you to pay for services. Therefore, if you are still facing issues with your dental insurance plan, you may need to change your dental office, not your dental insurance plan. I hope this information was helpful to you. If you have any additional questions, please do not hesitate to ask.

Question: I have a PPO that has a waiting period for almost everything. Since I have the plan for seven months, I only have five more months until I can have significant services. When I bought the plan, I did not think waiting periods would be an issue and that I could wait them out. Now, I need a crown that will cost about $900.00. After the waiting period, the insurance company that I am with will cover 50% of the cost.

I need the crown now; are there better ideas than waiting five more months? My dentist said I should get the crown now since it will help protect my chipped tooth. Can I get the crown and file the claim after the waiting period? That way, I will at least get my $450.00 back in the five months after I file the claim. I hate spending money that my insurance company should pay out for.

Reply: I can understand your frustration with waiting for the insurance company to cover the cost of your crown. It’s good that you have consulted with your dentist and know the importance of getting the crown to protect your chipped tooth. 

Consider asking your dentist if they offer any payment plans or financing options. A payment plan could allow you to get the crown and pay for it over time rather than waiting for your insurance to kick in. 

I would advise against filing the claim after the waiting period. Most insurance companies have policies requiring claims to be filed within a specific time frame, typically within a few months of the service date. 

It’s important to understand that filing a claim for a service received during a waiting period but saying it was after could be considered insurance fraud. If someone files a claim with false information, the insurance company may deny it, revoke the policy, or even pursue legal action.

Suppose an individual receives crown treatment during the waiting period of their insurance policy and submits a claim stating that the treatment was accepted after the waiting period. In such cases, the insurance company considers this act as fraudulent. If the insurance company uncovers this false information, it will reject the claim and inquire into the policyholder’s other claims and medical history. This could result in a considerable hike in insurance premiums or even policy cancellation. Moreover, most dental offices file the claim to the insurance company, and it is doubtful that they would mistakenly mislead the insurance company about the date of service.

In short, honesty is always the best policy for filing insurance claims. It’s essential to follow the insurance company’s rules and regulations and not engage in fraudulent activities. If you have any doubts or questions about your insurance policy, it’s always a good idea to contact your insurance provider for clarification.

Ultimately, the decision is up to you. It may be worth weighing the pros and cons of waiting for insurance coverage versus paying for the crown out of pocket and considering any payment options that may be available to you.

Consider a Temporary Crown for Your Chipped Tooth: Benefits, Insurance Coverage, and Advice from Dentist

You could discuss with your dentist the possibility of getting a temporary crown until your waiting period is over. Temporary crowns are acrylic and designed to protect your chipped tooth, maintain your bite, and prevent further damage until the permanent crown is ready.

Temporary crowns are typically much less expensive than permanent crowns, which could make them a more affordable choice for you. Some dental insurance policies cover the cost of temporary crowns, even during the waiting period before placing a permanent crown. It’s always a good idea to check with your dental insurance company’s member service to verify if they cover temporary crowns. If they do, it can help you make an informed decision about your dental care and save you money. Feel free to ask your dentist about the pros and cons of temporary versus permanent crowns and which option might suit your situation.

However, it’s essential to remember that temporary crowns are less durable and long-lasting than permanent crowns and will eventually need to be replaced. Your dentist can advise you on whether a temporary crown is the best option for your situation and help you make an informed decision.  

Getting a Dental HMO Insurance Plan

An alternative solution to consider when needing a crown during a waiting period is to purchase a dental HMO insurance plan that does not have waiting periods. This option can help reduce the crown cost if you have yet to start any work on the tooth that needs the crown. 

However, it’s important to note that this may require you to change to a different dental office that accepts the HMO plan. Fortunately, many dental offices accept HMO plans, so finding a new provider that meets your needs should not be difficult. Be sure to consult with your dentist and insurance provider to discuss this option and determine whether it is the right choice.

Dental Discount Plan May Help You Save Money During a Waiting Period

Dental discount plans are an alternative option that can help you save money on dental services, including crowns, during a waiting period. These plans are not insurance policies but membership-based programs offering discounted rates for dental services. 

Dental discount plans typically have no waiting periods and can be used immediately. You can enroll in a dental discount plan and access discounted dental services, including crowns, immediately, even if your current dental insurance plan has a waiting period.

One of the benefits of dental discount plans is that they often offer significant discounts on dental services. The discounts can vary depending on the plan and the provider, but they can range from 10% to 60% off the regular cost of dental services. 

Another advantage of dental discount plans is that they are generally easy to use. Once you sign up for the plan, you can present your membership card at the dental office to receive the discounted rate. No claim forms or waiting periods; you can use the plan as often as needed.

It’s important to note that dental discount plans are not insurance policies, so they do not cover the entire cost of dental services. Instead, they offer discounted rates to help you save money on dental care. Dental discount plans may be a good option for people who do not have dental insurance or who have a waiting period on their current dental insurance plan.

Cash Discount May be an Option 

If you choose to get the dental crown during the waiting period, it’s worth discussing with your dentist whether they offer a cash discount for services not filed with insurance. Some dental offices may provide a discount for patients who pay in cash, saving them the time and cost of filing an insurance claim. It’s always a good idea to ask your dentist about any discounts or payment options.

Additionally, a cash discount could help you save money in the long run, especially if you don’t plan on using your insurance for any other dental procedures during the waiting period. However, it’s essential to remember that not all dental offices offer a cash discount, and the discount amount can vary. 

Therefore, it’s essential to discuss the cost of the crown with your dentist and any payment options available. Being transparent with your dentist about your financial situation can help them better understand your needs and find ways to work with you to provide the best possible care.

Finding Affordable Dental Insurance Plans with Dental4Less.com

In conclusion, waiting for insurance coverage for necessary dental procedures can be frustrating, but it’s essential to avoid committing insurance fraud. Filing a claim with false information can lead to severe consequences, including policy cancellation, legal action, and a considerable hike in insurance premiums. Therefore, it’s crucial to consider alternative options when needing immediate dental care, such as payment plans, temporary crowns, or purchasing a dental HMO plan without waiting periods.

Dental4Less.com offers a wide range of dental plan types that can assist you in finding an affordable and reliable dental insurance plan that meets your specific needs. Our team of experts is available during business hours of M-F 8-4, and we’re always happy to help. We understand that dental care can be expensive, and we aim to provide options that make it more affordable while ensuring you receive the care you need.

We believe honesty is always the best policy when filing insurance claims. Therefore, we encourage you to avoid fraudulent activities and follow your insurance company’s rules and regulations. If you have any questions or doubts about your policy, please don’t hesitate to contact your insurance provider for clarification.

In summary, exploring alternative options and finding a dental insurance plan that meets your needs is a better and more honest approach than filing a claim with false information. Dental4Less.com can help you find affordable and reliable dental insurance plans that fit your budget and dental care needs. Contact us today at 310-534-3444 during our business hours of M-F 8-4, and let us assist you in finding the right plan for you.

You should think ahead when getting dental insurance.

It may seem surprising that many people do not have dental insurance. However, dental insurance benefits are only sometimes offered through work, so people do without until a significant dental need arises. The problem with waiting until you need dental insurance is that it can be too late to get the type of dental insurance you want. You may need a dental PPO plan to stay with your dentist.

However, most dental PPO plans have long-term waiting periods, so you may not get the coverage you seek when not bought early. If you have a dentist you do not wish to change, find out what dental plans you would need to stay with their dental office. If you are with a dental office that only accepts PPO dental plans, you should consider getting a PPO plan now to have a plan in place for your future dental needs, whether for preventive dental care or major dental care.

Are You Getting the Facts Before You Buy Dental Insurance?

When shopping for dental insurance online or through an agent, know all the facts about each type of dental plan before buying one. Mistakes happen when you need clarification on how a dental plan works. Purchasing dental insurance online is easy and convenient, but people need to read and understand what they buy. Before hitting the submit button, ensure you understand the plan’s terms.

Does the dental plan have waiting periods or yearly max dollar amount limitations? Is the dental insurance plan an in-network dental provider only, or can you go outside the network of dental providers? When is the insurance plan effective? Did you call the dentist to confirm they still accept the dental insurance plan? Is what you are reviewing a dental insurance plan or a dental discount plan? What are your dental needs, and are you getting a dental insurance plan that best fits them?

Taking the extra time to fully understand the dental plan you are buying will save you from headaches and being upset later on.

I do not have current dental insurance and very little money. My dentist told me I needed dental work on my teeth, so I started looking for dental insurance. Right now, insurance seems too costly for me, but some friends tell me to avoid dental discount plans because they are not insurance. Is this true?

Reply: That is correct. Dental discount plans are not insurance. Dental discount plans help you save money on your dental care cost as long as you go to a dentist who is a provider of the plan. Discount plans are an excellent way to help make dental care more affordable at a low cost. If you want dental insurance, consider reviewing dental HMO plans. Dental HMO plans are the more affordable dental insurance option.

What Dental PPO and Indemnity plans have to offer. Dental PPOs and Indemnity plans allow you to choose your dentist, and for many people, that can be a deciding factor in buying those types of dental insurance plans. For people who want to stay with their current dentist or to be able to choose their dental provider, these types of insurance plans are for that. Dental PPO and Indemnity plans are usually more costly than HMO’s dental insurance plans. Are dental PPOs and Indemnity insurance plans worth the cost? The answer is yes. If you know your dental needs and understand the terms and conditions of the insurance plan, many people are happy with their PPO plans. Trouble comes when you fully understand dental insurance plan’s limitations.

I need to understand how dental insurance works. I have a dental insurance PPO plan through my job, but it could be better. I am considering removing it and getting just the medical. Why have insurance if you have to pay the dentist?

Reply: Medical insurance has a cost paid out by the insured, too. Dental insurance is designed to make dental care more affordable, not necessarily free. You may not think dental care without insurance is so bad, but to give you an example of how even in preventive care, dental insurance is worth the cost. Say all you need is preventative care.

Without insurance, preventive care costs (Office visits, Bite-wing X-rays, Oral Exam, and Basic Cleaning) can range around $200 – $400, keeping in mind most low-cost HMOs plan range from $8.00 to $20.00 a month with preventive care typical being free. More extensive dental care services become expensive when you don’t have dental insurance.

While many seniors citizens are keeping their natural teeth longer they may have more complex dental care need to consider than previous generations. Due to increasing age comes the likelihood that more medications are being taken to chronic disease such as diabetes. Due to that it is important for the elderly to inform their dental professionals of any changes or updates in their medical history to ensure safe and effective dental care treatment.

I know many may not think of buying a dental insurance plan as a Christmas gift, but it really can be one the best gifts given to someone that truly keeps given.  If you know someone that would like to go to the dentist but can not afford too, because they do not have dental insurance, think about buying an HMO dental insurance plan.  These plans are normally really low in cost ranging $7.95 – $20.00 a month for an individual or annually around 80.00 – $220.00.

Another option is a dental discount plan that can cost around 7.95 – 9.95 a month and about $95.00 annually. Both of these plans type whether insurance or a discount plan can make having dental care services much more affordable to the person that would like to have dental care but not afford it.  Think about this as an option talk to the person and see if that is something that they would want and use if you got this for them.

Dental HMO insurance plans are normally the lower cost dental insurance option with few limitation and restrictions.  However it is important to understand it is also an insurance plans where you need choose a dentist in the plan network of providers.  There are no outside dental provider benefits.  You can not change to a different provider without making the change though the insurance company first.

Since you are choosing a plan dentist in an HMO dental insurance plan, make sure to call the dental providers up and confirm that they are still providers of the plan and accepting new plan members.  In addition ask any questions that are important to you in choosing a provider before buying the plan.  That way you can feel more comfortable with your choice of provider and buying the dental HMO insurance plan.

Tip: Make sure when buying any HMO dental insurance plan that they have more then just one dental provider in the miles you are willing to travel.  The more plan providers the better. This affords you more options in case you do what to change dental providers under the plan or if the current provider ever decides to stop accepting the plan you have other dental provider options left to you.