Does Dental Insurance Cover Root Canals?
Our patients with dental insurance commonly have this question. Please refer to the answers below which our endodontists and team have developed to help provide information that can help to answer this question and more.
Does my dental insurance work 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 per year? The maximum cumulative coverage for a “benefit year” for most dental plans is between $1,000 to $1,500. Dental insurance is never a “pay-all”; it is only an aid. This is often a surprise to the patients, 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 will make an 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% or as much as 80% of dental services.
What happens if I used all of my benefits on my insurance? Once your annual maximum has been reached, the insurance company will not provide additional benefits for any dental service until the renewal period. Each insurance 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 within 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 carrier within 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 was my benefit different from what I expected? Your dental benefit may vary because: you have already used some or all of the benefits available; your insurance plan paid only a percentage of the fee charged by our office; the treatment you needed was not a covered benefit; you have not yet met your deductible; or you have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
What is a “UCR” and how is it determined? “UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged by our office. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
How do I know what my payment portion will be if my insurance does not cover the entire fee? Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit and other factors. Ultimately, the patient portion is not known until the insurance check has been received by our office.
If you have additional questions for Bethesda-Chevy Chase Root Canal Specialists about root canal treatment and insurance coverage, please contact us today.