Dental Insurance 101

Understanding how dental insurance works can be a challenge, but we’re here to help guide you through the process so you have one less thing to worry about. We work with many insurance providers to help ensure that all patients have access to high-quality, affordable dental care.

Below we have answered some of the most common insurance-related questions to help you better understand your care. If you have additional questions, please contact your Park Dental practice.

Do You Accept My Dental Insurance?

In an effort to make dental care accessible for everyone, we accept most major dental insurance plans and many plans from smaller insurance providers as well. Some of the insurance plans we accept include Delta Dental, HealthPartners, Blue Cross, Cigna, Premier Dental, MetLife and many others. However, just because we accept coverage from specific insurance companies does not necessarily mean we accept your specific plan. It’s important to consult with your insurance company to determine if your Park Dental location is covered by your policy. We also accept a limited number of Medical Assistance patients. Please check with your Park Dental practice for availability.

How Do I File an Insurance Claim?

If you have valid dental insurance, we help in every way to file the claim on your behalf. When you schedule your appointment, we collect your insurance information. At your appointment, we will provide you with an estimate of your patient portion based on the information you provide to us. We submit the claim to your insurance company following your appointment. It typically takes 3 to 6 weeks for the insurance companies to respond with payment.

If I Have Insurance, Will I Have to Pay for My Visit?

Your insurance plan may cover all, a portion or none of your visit. We will provide you with an estimate of your patient portion at your appointment, and we will ask for this payment at the time of your appointment. For your convenience, we accept cash, check, debit card and major credit cards. Depending on your plan and the service you are receiving, you may owe nothing at the time of your visit.

My Insurance Company Sent Me an Explanation of Benefit. What does this mean?

Most insurance companies send an Explanation of Benefit (EOB) once they have processed your claim. It provides you with all the details regarding the claim, including what was covered and what you may owe. In some cases, the insurance company may not pay anything based on provisions in your contract. Please note that the EOB is not a bill. If you do owe an outstanding balance, you will receive a bill from us separately. Your insurance company will not bill you.

How Do I Pay My Balance?

After we have received payment from your insurance company, we will provide you with a statement summarizing any remaining balance you are responsible to pay. In the event your insurance company denies payment, you will be responsible for all charges incurred for your care. You will pay your balance to us using any of our convenient payment methods, including online payments through our website.

Why Didn’t My Insurance Cover My Care?

It’s important to know and understand your insurance policy. Please understand that Park Dental is not responsible for determining whether or not your care will be covered by insurance. There are many reasons why insurance might not cover your care. This is often dependent on your specific policy and other care you have received. If you have questions regarding why your care wasn’t covered, you will need to contact your insurance company directly.

I Don’t Have Dental Insurance. Can I Still Be a Patient?

Having dental insurance is not a requirement to be a patient at Park Dental. Many of our patients do not carry dental insurance. We offer a variety of payment options and payment plans, including Park Dental Care Packages.

How Do I Handle My Account if I Have More Than One Dental Insurance Policy?

If you have dual dental insurance (more than one active policy), we will help in every way to file your claims and handle insurance questions on your behalf. We will use the same process of filing a claim as we would for a patient with a single active policy, and we will also file the secondary claim on your behalf once your primary insurance company has paid any applicable benefit. Once both insurance companies have processed your claim, we will provide you with a statement for any remaining balance. In the event your insurance company denies payment for any reason, you will be responsible for all charges incurred for your care.

Dental Insurance Terminology

Deductible

– The amount of money that you must pay to your dentist out-of-pocket before your insurance company will pay for any services. This amount is set when purchasing or setting up the plan as a benefit.

 

Explanation of Benefits (EOB)

– This is a document prepared by the dental insurance company and issued to the patients and dentist. It explains how the insurance company has adjudicated the claim that was submitted for services provided to the patient.

 

Missing Tooth Clause

– Protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect.

 

Replacement Clause

– Protects the insurance company from paying to replace dentures, partials, bridges, etc., until a specified time limit has passed.

 

Waiting Period

– The length of time an insurance company will make you wait after you are covered before they will pay for certain procedures.

 

Yearly Maximum

– The total amount that your insurance company will pay for any services during the plan year. The yearly maximum renews every year, typically on January 1, but your plan may have set a different date.