Demystifying Dental Insurance: Answers to Your Insurance Questions

According to insurance law, when both parents carry separate insurance policies, the primary insurance coverage for their children is determined based on the parent with the earlier birthday. This rule is commonly referred to as the "birthday rule." The insurance company of the parent whose birthday falls earlier in the calendar year becomes the primary insurance for the children.

While we would love to wave our magic wand and provide you with all the juicy details, the reality is a bit different. Thanks to those pesky confidentiality laws, most insurance companies don't share that information with us. So despite our attempts, we may not be able to obtain your insurance specifics.

The best way to unravel the mysteries of your coverage is to channel your inner techie and embrace the wonderful world of apps or websites. Yes, that's right! Grab your smartphone or hop onto your trusty computer and log in to your insurance company's app or website.

So, while we can't promise you a dental insurance breakdown straight from our clinic, we empower you to take charge and explore the realm of apps and websites.

Ah, yes, insurance coverage and its maximum limit! It's like the insurance company saying, "I've got your back, but only up to a certain point." Let's delve into two common scenarios related to these limits and see how they work their magic.

Combined Maximum Amount (Annual or Cycle): Some insurance plans come with a combined maximum amount that can be spent within a specific period. We call it the annual maximum or cycle maximum. This total expense cap covers all the dental treatments within the policy. Once you hit this maximum, the insurance company taps out and takes a break from covering additional dental treatments until the next cycle or year begins.

Separate Maximums for Basic, Major, or Orthodontic Treatments: Now, this is where things get a bit categorical. Certain insurance plans like to play favorites, assigning separate maximum limits for different dental treatment categories. We're talking about basic, major, and orthodontic treatments. Each category gets its own annual maximum, determining the amount the insurance company will pay for services within that category.

Plan Number: The plan number identifies the specific dental insurance plan you have enrolled in. It's like giving your insurance policy its own license plate. This number helps the insurance company know which plan you belong to and what benefits and coverage you're entitled to.

Certificate Number: The certificate number is like the individual identification number within your dental insurance plan. It's assigned to each person covered under the plan, be it you or your family members, This number allows the insurance company to identify each member and track their individual dental adventures and claims.

Yes, many dental insurance plans have waiting periods before you can access certain services. The waiting periods can range from a few months to a year and are intended to prevent immediate claims for expensive treatments

Policyholder's Full Name: Provide the complete legal name of the person who holds the dental insurance policy.

Policy or Certificate Number: This unique identifier links you to your specific dental insurance plan.

Date of Birth: Your date of birth is required to confirm your identity and ensure the policy is associated with the correct individual.

Dependent Details: If you are adding dependents to your dental insurance, you'll need their full names, dates of birth, and relationship to you (e.g., spouse, child).

Group Number: Obtain the group number from your employer or the organization through which you obtained the dental insurance plan. It identifies individuals under the same insurance contract.

If your insurance does not accept electronic submission for claims, you have the option to manually submit the claim.
When your insurance does not support electronic submission, you will be responsible for paying the cost of your treatment upfront. The dental office will provide you with all the necessary claim submission forms and any supporting documentation required.
Typically, insurance companies process manual claims within a reasonable timeframe. In many cases, you can expect to receive your refund within 48 hours after submitting the claim. However, processing times may vary based on the insurance provider.

We could only submit predetermination to the primary insurance and not the secondary insurance. To find out what the 2nd insurance may cover, you may need to get a response from the insurance and communicate it with the secondary insurance. Unfortunately, they do not provide us with this information.

Though we could submit supporting documents on your behalf in support of extra units of scaling, insurance companies do not provide their decision directly to us. Keep an eye on your mailbox, as they typically send this information directly to the plan holder. Once you receive approval, please inform our office, and we will proceed with the additional cleanings as recommended by your dentist.